Percutaneous transhepatic cholangioscopy-assisted biliary polypectomy for local palliative treatment of intraductal papillary neoplasm of the bile duct.

BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant biliary-type epithelial neoplasm with intraductal papillary or villous growth. Currently reported local palliative therapeutic modalities, including endoscopic nasobiliary drainage, stenting and biliary curettage, endoscopic biliary polypectomy, percutaneous biliary drainage, laser ablation, argon plasma coagulation, photodynamic therapy, and radiofrequency ablation to relieve mechanical obstruction are limited with weaknesses and disadvantages. We have applied percutaneous transhepatic cholangioscopy (PTCS)-assisted biliary polypectomy (PTCS-BP) technique for the management of IPNB including mucin-hypersecreting cast-like and polypoid type tumors since 2010. AIM: To assess the technical feasibility, efficacy, and safety of PTCS-BP for local palliative treatment of IPNB. METHODS: Patients with mucin-hypersecreting cast-like or polypoid type IPNB and receiving PTCS-BP between September 2010 and December 2019 were included. PTCS-BP was performed by using a half-moon type snare with a soft stainless-steel wire, and the tumor was snared and resected with electrocautery. The primary outcome was its feasibility, indicated by technical success. The secondary outcomes were efficacy, including therapeutic success, curative resection, and clinical success, and safety. RESULTS: Five patients (four with mucin-hypersecreting cast-like type and one with polypoid type IPNB) were included. Low- and high-grade intraepithelial neoplasia (HGIN) and recurrent IPNB with invasive carcinoma were observed in one, two, and two patients, respectively. Repeated cholangitis and/or obstructive jaundice were presented in all four patients with mucin-hypersecreting cast-like type IPNB. All five patients achieved technical success of PTCS-BP. Four patients (three with mucin-hypersecreting cast-like type and one with polypoid type IPNB) obtained therapeutic success; one with mucin-hypersecreting cast-like type tumors in the intrahepatic small bile duct and HGIN had residual tumors. All four patients with mucin-hypersecreting IPNB achieved clinical success. The patient with polypoid type IPNB achieved curative resection. There were no PTCS-BP-related serious adverse events. CONCLUSION: PTCS-BP appears to be feasible, efficacious, and safe for local palliative treatment of both mucin-hypersecreting cast-like and polypoid type IPNB.

Heterostructured Graphene@Silica@Iron Phenylphosphinate for Fire-Retardant, Strong, Thermally Conductive Yet Electrically Insulated Epoxy Nanocomposites.

The portfolio of extraordinary fire retardancy, mechanical properties, dielectric/electric insulating performances, and thermal conductivity (λ) is essential for the practical applications of epoxy resin (EP) in high-end industries. To date, it remains a great challenge to achieve such a performanceportfolio in EP due to their different and even mutually exclusive governing mechanisms. Herein, a multifunctional additive (G@SiO2@FeHP) is fabricated by in situ immobilization of silica (SiO2) and iron phenylphosphinate (FeHP) onto the graphene (G) surface. Benefiting from the synergistic effect of G, SiO2 and FeHP, the addition of 1.0 wt% G@SiO2@FeHP enables EP to achieve a vertical burning (UL-94) V-0 rating and a limiting oxygen index (LOI) of 30.5%. Besides, both heat release and smoke generation of as-prepared EP nanocomposite are significantly suppressed due to the condensed-phase function of G@SiO2@FeHP. Adding 1.0 wt% G@SiO2@FeHP also brings about 44.5%, 61.1%, and 42.3% enhancements in the tensile strength, tensile modulus, and impact strength of EP nanocomposite. Moreover, the EP nanocomposite exhibits well-preserved dielectric and electric insulating properties and significantly enhanced λ. This work provides an integrated strategy for the development of multifunctional EP materials, thus facilitating their high-performance applications.

Stem cell gene Girdin: a potential early liver metastasis predictor of colorectal cancer.

The objective of this study is to investigate the liver's metastasis-related genes and the relationship between Girdin protein expression and clinical and pathological characteristics and prognosis in colorectal cancer. The differential expression of genes between tumor cells from cases with liver metastasis and those from cases without liver metastasis were detected using an RT(2) Profiler™ PCR Array. The expression of the stem cell gene Girdin was analyzed using immunohistochemistry staining. Subsequently, the relationship between Girdin and clinicopathological parameters of colorectal cancer was determined. The Girdin protein was verified as a gene related to liver metastasis and was expressed positively in 161 (37.01 %) of the 435 cases examined. The expression of Girdin protein was related to histological grade and distant metastasis (P = 0.007 and 0.007, respectively). After analyzing survival rates, cases with highly expressed Girdin protein were shown to attain a significantly higher rate of liver metastasis and poorer postoperative, disease-specific survival than those with no or low expressed Girdin protein (P = 0.001). In the Cox regression test, the depth of tumor invasion, histological grade, duke's stage, distant metastasis, and the Girdin protein were detected as an independent prognostic factor (0.020, 0.032, 0.001, 0.001, and 0.010, respectively). The Girdin protein may be a potential new early liver metastasis biomarker of colorectal cancer.