Large Duct Research Articles

Abstract 2557: Germline mutation landscape in a large cohort of Chinese pancreatic cancer patients

Abstract Background: Our knowledge of the prevalence of germline mutations associated with pancreatic cancer risk largely came from studies conducted in the Caucasian population. Therefore, there is an urgent need to characterize germline mutations of pancreatic cancer susceptibility genes in the non-Caucasian populations. In this study, we comprehensively analyzed germline mutations in known and candidate pancreatic cancer susceptibility genes in a large Chinese pancreatic duct adenocarcinoma (PDAC) cohort. Methods: Unselected PDAC patients were recruited from 2017 to 2020 and their genomic DNA sample was profiled by a 139-gene NGS panel. We quantified the prevalence of deleterious germline mutations in this Chinese cohort and compared it with published PDAC germline mutation profiling data. Results: In this 546 Chinese PDAC patient cohort, 64 deleterious germline mutations were found in 63 (11.5%) patients. Thirty-one (5.7%) patients carried a deleterious mutation in a pancreatic cancer susceptibility gene: 15 (2.7%) with BRCA1 (n =3) or BRCA2 (n =12) mutations, five with ATM, seven with PALB2, two with MSH6 and one each with a mutation in CDKN2A or TP53. Moreover, 24 (4.4%) patients had deleterious mutations in additional DNA damage repair (DDR) genes including BLM (n =1), NBN (n =1), RAD50 (n =1), RAD51D (n =2), RECQL4 (n =1), WRN (n =2) of the homologous recombination repair (HRR) pathway, ERCC2 (n =1), ERCC4 (n =1), ERCC5 (n =1) of the nucleotide excision repair (NER) pathway, BRIP1 (n =2), FANCC (n =1), FANCD2 (n =2), FANCM (n =2) of the Fanconi anemia (FA) pathway, MSH3 (n =2), PMS2 (n =1) of the mismatch repair (MMR) pathway, MUTYH (n =3) and MRE11A (n =1). The average age at diagnosis of patients with PDAC identified as having a germline mutation in a known (ATM, BRCA1, BRCA2, CDKN2A, MSH6, PALB2 and TP53) pancreatic cancer susceptibility gene was 54.2 ± 10.0 years, significantly lower than the average age of the patients without an identifiable susceptibility gene mutation (60.3 ± 10.6 years; P =0.002). We also compared PDAC-associated germline mutation frequency between our cohort (n =546) and the Mayo Clinic cohort (n =3030) to determine the similarity and difference of PDAC germline mutation landscape between Chinese and Caucasian populations. Of note, the mutation frequencies of ATM and PALB2 were 0.91% and 1.28% in our cohort, significantly lower and higher than 2.28% of ATM (P<0.05) and 0.40% of PALB2 (P =0.02) in the Mayo Clinic cohort, respectively. Conclusions: We found that nearly 12% patients in this Chinese PDAC cohort carry deleterious germline mutations, mainly in established pancreatic cancer susceptibility genes and DDR genes. Our data indicated that the PDAC germline mutation landscape of Chinese population is largely similar to that of the Caucasian population and the NCCN PDAC genetic screen guideline can be applied to the clinical management of PDAC patients of Asian descent. Citation Format: Zhiming Zhao, Xiaomo Li, Fei Wang, Tonghui Ma, Rong Liu. Germline mutation landscape in a large cohort of Chinese pancreatic cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2557.

Case study: Correlation between boundary and finite element determination of large silencer transmission loss

Silencers used in the power generation industry generally have large ducts entering and leaving the silencer. With large cross-sectional dimensions, the plane wave cutoff frequency will be exceeded at a low frequency so that transmission loss can no longer be evaluated by assuming constant sound pressure over a cross-section. More sophisticated calculation and processing approaches are necessary. In this research, the boundary element method is used in conjunction with a reciprocal identity method to determine the transmission loss for rectangular and circular cross-sections: the two configurations that cover most real-world designs. The boundary element method is compared to a finite element method strategy where the transmission loss is determined using an automatically matched layer boundary condition at the inlet and outlet. This approach can be used in most commercial software. Although these two approaches have little in common, transmission loss results compare well with one other. Validation by comparison is helpful because analytical solutions are only available for simple axisymmetric cases. Methods are compared for practical configurations like parallel-baffle silencers and reactive silencers.

Conditions for Topside Ion Line Enhancements

AbstractEnhanced ion line spectra as a response to magnetic field‐aligned high frequency (HF) pumping of the overdense polar ionosphere with left‐handed circular polarization, can be observed at the top and bottomside F‐region ionosphere under certain conditions. The European Incoherent Scatter (EISCAT) UHF radar was directed in magnetic zenith on October 18th and 19th, 2017 while stepping the pump frequency of the EISCAT Heating facility both upward and downward across the double resonance frequency of the fourth harmonic of the electron gyrofrequency and the local upper hybrid frequency, in a 2‐min‐on, 5‐min‐30‐s‐off pump cycle. We present observations of two separate cases of topside HF‐enhanced ion lines (THFIL). THFIL simultaneous to bottomside HFIL (BHFIL), and conditioned by the relative proximity of the HF pump frequency to the bottomside double resonance frequency, consistent with previous observations (Rexer et al., 2018, https://doi.org/10.1029/2018JA025822) were observed for HF pulses on 19th October. Recurring THFIL appearing after BHFIL have faded and conditioned by the relative proximity to the double resonance frequency on the topside ionosphere, were observed on 18th October. The THFIL are consistent with transionospheric propagation through artificial radio windows by L mode guiding of the pump wave, facilitated by large scale density ducts present in the plasma.

A case report of spontaneous passage of large (>1.5 cm) common bile duct calculi (4 in number) through faeces

Gallbladder (GB) stones are commonly associated with common bile duct stones (CBDS). While they may remain asymptomatic, some may present with symptoms like biliary colic, jaundice and cholecystitis. Most of these stones in the CBD, if small, pass through faeces. Passing larger stones through faeces is relatively rare and if it does occur, is usually associated with fatal complications like acute pancreatitis. The authors reported a case wherein symptomatic large CBD stones were spontaneously passed through faeces and the patient was relieved of the symptoms and did not suffer any further complications. Choledocholithiasis is usually managed by endoscopic retrograde cholangiopancreatography or by laparoscopic or open choledocholithotomy. Spontaneous passage of small CBD and GB calculi through faeces although common is associated often with the development of pancreatitis. Passage of large CBD calculi (size >1.5 cm) through faeces is rarely seen.

Role of Macrophages in Cytotoxicity, Reactive Oxygen Species Production and DNA Damage in 1,2-Dichloropropane-Exposed Human Cholangiocytes In Vitro.

1,2-Dichloropropane (1,2-DCP), a synthetic chlorinated organic compound, was extensively used in the past in offset color proof-printing. In 2014, the International Agency for Research on Cancer (IARC) reclassified 1,2-DCP from its initial Group 3 to Group 1. Prior to the reclassification, cholangiocarcinoma was diagnosed in a group of workers exposed to 1,2 -DCP in an offset color proof-printing company in Japan. In comparison with other forms of cholangiocarcinoma, 1,2-DCP-induced cholangiocarcinoma was of early onset and accompanied by extensive pre-cancerous lesions in large bile ducts. However, the mechanism of 1,2-DCP-induced cholangiocarcinoma is poorly understood. Inflammatory cell proliferation was observed in various sites of the bile duct in the noncancerous hepatic tissues of the 1,2-DCP-induced cholangiocarcinoma. The aim of this study was to enhance our understanding of the mechanism of 1,2-DCP-related cholangiocarcinogenesis. We applied an in vitro system to investigate the effects of 1,2-DCP, using MMNK-1 cholangiocytes cultured alone or with THP-1 macrophages. The cultured cells were exposed to 1,2-DCP at 0, 0.1, 0.2, 0.4, and 0.8 mM for 24 h, and then assessed for cell proliferation, cell cytotoxicity, DNA damage, and ROS production. Exposure to 1,2-DCP increased proliferation of MMNK-1 cholangiocytes cultured alone, but not those cultured with macrophages. 1,2-DCP also increased LDH cytotoxicity, DNA damage, and ROS production in MMNK-1 cholangiocytes co-cultured with macrophages but not those cultured alone. 1,2-DCP increased TNFα and IL-1β protein expression in macrophages. The results highlight the role of macrophages in enhancing the effects of 1,2-DCP on cytotoxicity, ROS production, and DNA damage in cholangiocytes.

Construction optimization of PBA of Subway station tunnel excavation and its cross section in loess area

This paper takes the project of Hejiaying Station of Xi’an Subway Line 2 as the background for the study. The dynamic numerical simulation of the construction process of the station by the PBA method is carried out using the 3D finite element method. The changes of surface settlement, vault settlement, headroom convergence and structural stresses are studied up to the intersection of the guide tunnel and large section duct. The research results show that: the construction of the upper guide hole of the station has a small effect on the deformation and internal force of the initial support structure of the duct. The construction of the lower pilot hole will increase the deformation and internal force of the initial support structure of the duct, especially the construction of the lower 2 pilot holes and the lower 3 pilot holes will lead to a significant increase in the deformation and internal force of the initial support structure of the duct. Therefore, it is necessary to make a 10m reservation for the lower guide hole of the main line, and to grout the cross section of the lower guide hole to ensure the safe construction of the cross section.

Características e impacto del sexo en una cohorte de pacientes con colangitis esclerosante primaria: experiencia de un centro trasplantador de la cuenca mediterránea

Background and aimsPrimary sclerosing cholangitis (PSC) is a rare cholestatic liver disease that typically affects middle-aged men with ulcerative colitis (UC). However, recent studies point out to epidemiological changes. Our aim was to determine if the epidemiology, clinical course and outcome of patients with PSC followed at a reference hepatology center resemble what is described in the literature. Patients and methodRetrospective search of patients with a diagnosis of PSC treated in our center between 2000 and 2019. ResultsCohort of 55 patients (mean age: 37 years), 44% women. Most were large duct type (79%). Most diagnoses were made after 2011. At time of diagnosis, 63% of patients were asymptomatic. The median time from suspicion to diagnosis was 2 years. After a mean follow-up time of 7 years, one third developed cirrhosis, and 25% required liver transplantation (LT); among these, the disease recurred in almost half. Inflammatory bowel disease (IBD) was present in 45%, especially UC. Although statistical significance was not reached, PSC in women was characterized by higher rate of asymptomatic presentation and more frequent association with UC versus other forms of IBD. Women also had more frequently cirrhosis at diagnosis and required LT more often than men. ConclusionThe epidemiology of PSC is changing. The number of women affected is greater than what was expected from the literature, with a recent increase in incidence. There seems to be differences between sexes in the form of presentation and disease course that should be confirmed in subsequent studies.

Electrohydraulic lithotripsy under the mother-baby cholangioscope system using a colonoscope for large common bile duct stones in a patient with Roux-en-Y reconstruction.

Video 1After insertion of the cholangioscope into the common bile duct, electrohydraulic lithotripsy was performed. All common bile duct stones were shattered and successfully removed using a basket and balloon catheter.

Clinical practice guidelines for intraductal papilloma: Chinese Society of breast surgery (CSBrS) practice guidelines 2021.

Clinical practice guidelines for intraductal papilloma: Chinese Society of breast surgery (CSBrS) practice guidelines 2021.

Cholangiopathy After Severe COVID-19: Clinical Features and Prognostic Implications.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging. We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database. Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation. Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions.

Determination of acoustic free sources in large cross-section ducts

Blocked forces are determined at the interface between source and receiver structures. Recent investigations have shown that these forces can be determined using inverse methods. Once determined, they can be used to drive simulation because they are independent of the receiver. This methodology has been primarily used for structural applications. This research demonstrates that a similar procedure can be used to determine acoustic free sources on a plane along the cross-section of a duct with the downstream portion of the duct serving as the receiver subsystem. This may be considered as a three-dimensional equivalent of source impedance and source strength. If a continuous source distribution is applied across the plane, these sources should be appropriate regardless of how the system is modified downstream so long as the upstream geometry is unchanged. The approach is first validated using acoustic finite element simulation. It is then demonstrated experimentally using a source room as the source component and an attached duct as the receiver component. Sources are determined along a cross-sectional plane within the duct. The downstream side of the duct is then modified, and it is shown that the acoustic free sources predict the downstream response successfully.

Resin ducts and bark thickness influence pine resistance to bark beetles after prescribed fire

After fire, bark beetles pose a significant threat to trees. Resin duct characteristics in trees can increase resistance to bark beetles. However, little is known about how intra- and interspecific variations in resin ducts due to tree characteristics, fire-caused tree injury and life history traits contribute to resistance. In fall 2013, a mixed-stand of Pinus sylvestris and P. nigra was underburned, with some trees subsequently attacked and killed by bark beetles (Ips sexdentatus) during the following two years. We investigated whether inter- or intraspecific differences in constitutive defenses (i.e. bark thickness, tree size and growth, resin ducts) or fire-caused tree injury could explain tree resistance to bark beetles. Beetles preferentially attacked P. sylvestris over the more fire-resistant P. nigra subsp. salzmannii. In P. nigra, attacks were limited to smaller trees, whereas the probability of mortality from I. sexdentatus increased with diameter in P. sylvestris. The decrease in bark thickness along the stem significantly affected the probability of mortality in P. sylvestris but not in P. nigra. As tree size increased, bark thickness and resin duct area investment were lower in P. sylvestris than P. nigra, suggesting reduced defences in P. sylvestris. For both species, pines that survived had faster growth, higher resin duct area, and fewer but larger ducts than pines that died after the attack. However, resin duct area and density rather than growth or fire-caused injury were better predictors of tree resistance. Moreover, in unattacked trees resin duct area increased with diameter in P. nigra. Our study showed that bark beetles attacks were tree species and size specific, but ultimately resin duct characteristics determined host colonization. Our findings suggest managers can expect higher delayed mortality from bark beetles in P. sylvestris after burning; however, actions that encourage faster growth may increase resin duct-related defences in both pine species.

Risk Factors for Perforation During Endoscopic Papillary Large Balloon Dilation and Bile Duct Stone Removal.

Stone removal using endoscopic papillary large balloon dilation (EPLBD) is extremely effective. However, limited research exists regarding the risk factors for perforation of the duodenal papilla and bile duct, which may be fatal. We aimed to investigate the risk factors for perforation during EPLBD + stone removal. We included patients who underwent EPLBD + stone removal at four medical facilities between January 2008 and December 2018. We retrospectively analyzed the risk factors for perforation and their relationship between overdilation and adverse events. Overdilation was defined as a ratio of the balloon diameter to the diameter of the bile duct that exceeded 100%. The diameter of the distal bile duct was measured using the diameter of the intrapancreatic bile duct at a point 10mm toward the liver from the narrow distal segment on a cholangiogram. We included 310 patients (177 males; median age: 79years [range: 46-102years]). Perforation occurred in five patients (1.6%). Multivariate analysis indicated that no surrounding-pancreas (half or less of the circumference of the intrapancreatic bile duct was surrounded by the pancreatic parenchyma) was a significant risk factor (perforation rate: 8.3%, p = 0.011, odds ratio: 12.7 [95% confidence interval: 1.8-90.5]). No significant difference was found between the overdilation and non-overdilation groups regarding the occurrence of pancreatitis, bleeding, and cholangitis. Perforation rate in patients with no surrounding pancreas + overdilation was 16.7% (2/12). Patients with perforation underwent conservative therapy, which improved their conditions. EPLBD + stone removal should be avoided in patients with no surrounding pancreas. Overdilation is not a risk factor for adverse procedural events; however, it should be limited in patients with surrounding pancreas.

Secretin Treatment Promotes Hepatic Progenitor Cell Activation, Ductal‐Canalicular Junction Formation and Amelioration of Liver Damage in a Model of Late‐Stage Primary Biliary Cholangitis

Introduction PBC is a cholestatic disease characterized by bile duct loss, ductular reaction and liver fibrosis. The canals of Hering (CoH) are the site of ductulo-canalicular junction (DCJ) that maintain proper bile drainage from the liver, and contain the hepatic progenitor cell (HPC) population. CoH loss is noted in PBC and correlates with scoring. Secretin binds to its receptor (SR, expressed by large cholangiocytes) to promote biliary proliferation during cholestasis; however, during large duct damage, small cholangiocytes acquire large cholangiocyte phenotypes including SR expression. Secretin/SR expression is downregulated in late-stage PBC; therefore, we aimed to understand the role of the secretin/SR axis during PBC. We hypothesized that secretin treatment restores DCJ through HPC activation and ameliorates liver phenotypes associated with late-stage PBC. Methods Female 34 wk old wild-type (WT) and dominant-negative transforming growth factor-β receptor II (dnTGFβRII, model of late-stage PBC) mice were treated with control or secretin (2.5 nmol/kg BW) for 8 wk by IP implanted minipumps. Cholangitis activity, hepatitis activity and bile duct loss were determined by the Nakanuma scoring system. Ductular reaction was measured by semi-quantitative CK-19 immunostaining. Liver fibrosis was evaluated by Sirius Red staining, collagen-1a immunostaining and qPCR for α-SMA. Hepatic stellate cell (HSC) presence was determined by desmin immunostaining. Cholestasis was indicated by hepatic total bile acid (TBA) levels using EIA. DCJ presence was evaluated by co-immunostaining for ABC transporter bile salt export pump (BSEP)/CK-19 and semi-quantification. HPC activation was assessed by Sox9 staining and semi-quantification. Results dnTGFβRII mice had an increase in cholangitis and hepatitis activity; however, 8 wks of secretin treatment significantly reduces cholangitis, but not hepatitis, activity. dnTGFβRII mice present with ductular reaction and significant bile duct loss, which was reversed with 8 wks secretin treatment. Hepatic TBA levels, liver fibrosis and HSC presence are increased in dnTGFβRII mice, but significantly reduced following 8 wks of secretin treatment. In line with human studies, dnTGFβRII mice have significant loss of DCJ and reduced HPC number; however, 8 wks of secretin treatment restores these parameters. Conclusion Long-term secretin treatment (i) reduces ductular reaction, (ii) reverses bile duct loss, (iii) decreases liver fibrosis, (iv) promotes HPC activity and (v) restores DCJ presence in a model of late-stage PBC. Secretin maintenance of the DCJ may be due to (i) the restoration of bile flow and release of toxic bile acids or (ii) secretin binding to SR acquired on small cholangiocytes/HPCs. Treatment with secretin may be a therapeutic option for late-stage PBC patients.

Abstract No. 215 Percutaneous cholecystolithotomy: a single-institution experience with SpyGlass DS cholangioscopy

Percutaneous cholecystolithotomy using cholecystoscopy can be an alternative to cholecystectomy in high surgical risk patients with calculous cholecystitis. The purpose of this study is to describe our experience of percutaneous cholecystolithotomy using Spyglass direct visualization cholangioscopy (SpyGlass DS, 10F, Boston Scientific). The Institutional Review Board approved this retrospective study with a waiver of informed consent. Between January 1, 2018, and September 9, 2020, 18 patients (M:F = 13:5, mean 73 years) underwent percutaneous cholecystolithotomy using SpyGlass DS cholangioscopy for calculous cholecystitis. Percutaneous cholecystolithotomy was performed with SpyGlass DS cholangioscopy after placement of 16F sheath. Stone fragmentation was performed with EHL probe and stones were removed using baskets or saline flushing technique. Procedure details, technical success, complications, and clinical follow up were retrospectively analyzed. Eighteen patients underwent 28 percutaneous cholecystolithotomy procedures using SpyGlass DS cholangioscopy including seven patients for a second and three patients for a third cholecystolithotomy session. Conscious sedation was used in the majority of cases 86% (n = 24) versus general anesthesia 14% (n = 4) for the procedure. The median time interval between cholecystostomy tube placement and 1st cholecystolithotomy was 78 days. Overall technical success rate (removal of all stones) was 78% (14/18 patients) after repeat cholecystolithotomy. The median time from cholecystostomy tube placement to final tube removal was 111 days. Cause of technical failure were large, impacted stones (n = 3) and cystic duct occlusion (n = 1). There were three procedure related complications (acute pancreatitis causing mortality (n = 1), fistula to the skin requiring surgical excision (n = 1), bile leak requiring replacement of cholecystostomy tube due to gallbladder dyskinesia (n = 1)). There is no recurrence of symptomatic cholecystitis in patients with technical success. Three patients died because of reasons unassociated with the procedure during follow up. Percutaneous cholecystolithotomy using SpyGlass DS cholangioscopy can be performed with smaller sheath (16F) than conventional cholangioscopy (24F sheath) and can be a very useful alternate minimally invasive technique for gallstone management with high technical success rates.

Simulation Research of Airflow in the Prefabricated Large Duct Elbow with Different Deflectors

For the large air duct with inner and outer arc elbows commonly used in engineering, the forms of setting internal deflector will led to different diversion effects, which will affect the airflow uniformity, energy and pressure loss as well as noise in the elbow. In this paper, the comparison of different diversion forms, spacing and number of pieces in large air duct with inner and outer arc elbow are carried out. This paper aims to provide reference for engineering construction by using visualization technology.

Histological Patterns of Hepatitis and Cholangitis

Histological Patterns of Hepatitis and Cholangitis

Biliary atresia liver histopathological determinants of early post-Kasai outcome

BackgroundA retrospective chart review of liver histologies in Kasai biliary atresia BA patients operated 1/2017- 7/2019 at our institution was conducted to identify histologic prognostic factors for biliary outcome. MethodsPatients with wedge liver biopsies and portal plate biopsies (n = 85) were categorized into unfavorable and favorable outcome, based on a 3-month serum total bilirubin level of <34 μM or mortality. Hepatocellular histologies, presence of ductal plate malformation (DPM) and of large bile duct of ≥ 150 μm diameter size at the portal plate were evaluated. ResultsTotal Bilirubin levels> 34 μM correlates with worse 1-year survival. Age at surgery, histologic fibrosis or inflammation does not predict outcome. Potential adverse predictors are severe hepatocellular swelling, severe cholestasis, presence of DPM (n = 24), and portal plate bile duct size < 150 µm (n = 28). In multivariate analyses adjusting for age at Kasai and postop cholangitis, bile duct size and severe hepatocellular swelling remain independent histologic prognosticators (OR 3.25, p = 0.039 and OR 3.26, p = 0.006 respectively), but not DPM. ConclusionAdvanced histologic findings of portal plate bile duct size of <150 µm and severe hepatocellular damage predict poor post-Kasai jaundice clearance and short-term survival outcome, irrespective of Kasai timing.Level of Evidence: Level III

Effect of ibuprofen for hemodynamically significant patent ductus arteriosus closure on the development of acute kidney injury in preterm infants

Premature infants with hemodynamically significant patent ductus arteriosus (HSPDA) have a high risk of developing acute kidney injury (AKI) due to renal hypoperfusion and use of ibuprofen for duct closure. The aim of the study was to evaluate the effect of ibuprofen for the closure of HSPDA on the development of AKI in preterm infants depending on high dose of the drug on the first day of life. 40 preterm infants with HSPDA who were admitted for observation on the first day of life were examined. To close the ductus arteriosus, infants received restrictive therapy. In addition, 32 (80,0%) preterm infants on the first day of life were prescribed ibuprofen: 19 infants – in high dose (20 mg/kg), 13 infants – in standard dose (10 mg/kg). Clinical examination and treatment of preterm infants was carried out according to the generally accepted methods. Echocardiography with Doppler was performed at 5-11 hours of life and then daily to determine the size and hemodynamic significance of patent ductus arteriosus. Diagnosis and stratification of the severity of AKI were performed according to the criteria of neonatal modification of KDIGO, for which the concentration of serum creatinine and diuresis were studied. According to the results of the study, it was established that the frequency of AKI on the third and fifth days of life in preterm infants with HSPDA, who received ibuprofen in a high dose (20 mg/kg) on the first day, was 73.7% and 84.2%, respectively, which is 2.2 (OR=5.6; CI: 1,43-21,95; р&lt;0.02) and 2.5 (OR=10.67; CI: 2.31-49.31; р&lt;0.002) times, more often than in infants without such therapy. High dose of ibuprofen on the first day of life in preterm infants with HSPDA are most often associated with the development of stage I AKI on the third or fifth day of life, which was temporary in one third of patients. The use of a high-dose ibuprofen for HSPDA closure on the first day of life in preterm infants was significantly more often associated with foci of infection in the mother, large duct size and furosemide use.

Immediate or Interval Endoscopic Papillary Large-balloon Dilation after Limited Endoscopic Sphincterotomy for Bile Duct Stone Removal.

Objective Endoscopic papillary large-balloon dilation (EPLBD) with limited endoscopic sphincterotomy (EST) is widely used for removing multiple large common bile duct (CBD) stones. However, the safety and effectiveness of immediate EPLBD after limited EST and EPLBD at an interval after limited EST is unclear. Thus, this multicenter retrospective study was conducted to examine this matter. Methods Propensity score-matching was performed to adjust the baseline characteristics between the immediate and interval EPLBD groups. We compared the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) complications and the early outcomes of ERCP between the 2 matched groups, which comprised 66 patients each. Results The complete stone clearance rate in each study group was 100%. The overall incidence of post-ERCP complications in the propensity score-matched interval and immediate EPLBD groups was 3/33 (9.1%) and 1/33 (3.0%), respectively (p=0.61). The immediate EPLBD group had significantly fewer mean ERCP sessions for complete stone removal and a significantly lower rate of endoscopic mechanical lithotripsy (EML) usage than the interval EPLBD group [1.6 vs. 2.4 sessions, p<0.001; and 4/33 (12.1%) vs. 12/33 (36.4%), p=0.042, respectively]. Conclusion The incidence of post-ERCP complications in the immediate EPLBD group was not significantly different from that in the interval EPLBD group. Compared with interval EPLBD, immediate EPLBD may result in a reduced number of ERCP sessions for complete stone clearance and reduce the rate of EML usage.