enrolment.Background and aim Fully covered self-expandable metal stents (FCSEMSs) have been increasingly used in the management of benign or malignant biliary disorders. However, the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) with transpapillary placement of the FCSEMS remains controversial. This study therefore aimed to investigate the risk of PEP in patients who received FCSEMS implantation. Methods In total, 602 patients who underwent endoscopic transpapillary FCSEMS placement at five Chinese medical centers, between 2011 and 2018, were included in this retrospective study. Patients who were younger than 18 years and with stent placement above the papilla were excluded from the study. PEP and the risk factors were reviewed. Results PEP occurred in 56 (9.3%) patients, and eight (1.3%) of them experienced moderate-to-severe PEP. The incidence of PEP rose to 14.6% (51/349) when patients had no pancreatic duct (PD) dilation, and even to 18.6% if no prophylactic approaches were adopted. Prophylactic PD stenting showed better efficacy in reducing the incidence of PEP than did rectal use of indomethacin (3.5% vs 10.8%, P = 0.023). Multivariate logistic regression revealed that difficult cannulation (OR 2.837, 95% CI 1.245-6.465, P = 0.013), PD dilation (OR 0.145, 95% CI 0.05-0.422, P less then 0.001), and PD stenting (OR 0.247, 95% CI 0.089-0.686, P = 0.007) were significantly associated with PEP risk. Post-procedure cholecystitis was found in 4.0% of patients. Conclusion The risk of post-procedure pancreatitis is modestly increased in patients receiving transpapillary FCSEMS placement, particularly when there is absence of PD dilation. Thus, prophylactic pancreatic stenting is recommended in such a condition.This study established a spectrum-effect relationship method for screening and quantifying the analgesic and anti-inflammatory active ingredients in Angelicae Pubescentis Radix (AP) by ultra-high-performance liquid chromatography-quadrupole mass spectrometry detector analysis (UPLC-QDA). First, the fingerprint of AP was established to determine the common peaks. Next, six batches of AP samples, with significant differences, were selected for evaluation of pharmacological activity. Subsequently, the spectrum-effect relationship was used to screen the active ingredients. Finally, the screened ingredients were quantified using UPLC-QDA. In total, 21 common peaks were identified and four effective compounds (bergapten, columbianetin acetate, osthole and isoimperatorin) were selected using the gray relational analysis and partial least squares regression analysis. Quantitative analysis showed that the content of the four effective compounds was the highest in a randomly selected batch, S7 (Hubei). To our knowledge, this is the first attempt that evaluated the quality and spectrum-effect relationship of AP by quantitative analysis and chemometrics. This study identified the key pharmacologically active components of AP and thereby improved the quality evaluation system of AP. This method has broad application prospects for screening effective components and will be helpful in establishing more reliable, scientific and reasonable quality standards for AP and other traditional Chinese medicines.Aims Histology-based tumour microenvironment (TME) scores are useful in predicting the prognosis of gastrointestinal cancer. However, their prognostic roles in distal bile duct cancer (DBDC) have not been previously studied. This study aimed to evaluate the prognostic significance of the TME scores using the Klintrup-Mäkinen (KM) grade, tumour stroma percentage (TSP), and the Glasgow microenvironment score (GMS), in resected DBDC. Methods and results Eighty-one patients with DBDC who underwent curative resection were enrolled. DBDC was graded according to KM grade, TSP, and GMS. A high KM grade was found in 19 patients (24%), and a high TSP was found in 47 patients (58%). A high TSP was significantly correlated with a low KM grade (P less then 0.001). The distribution of the GMS, which was developed by combining the KM grade and TSP, was as follows 0 (n=19, 24%), 1 (n=19, 24%), and 2 (n=43, 52%). A low KM grade, high TSP, and high GMS were significantly associated with short overall survival (OS) (P less then 0.001) and relapse-free survival (RFS) (P less then 0.001). Furthermore, multivariate analysis showed that a low KM grade (hazard ratio [HR], 3.826; confidence interval [CI], 1.650-8.869; P=0.014), high TSP (HR, 2.193; CI, 1.173-4.100, P=0.002), and high GMS (HR, 7.148; CI, 2.811-18.173) were independent prognostic factors for short RFS; a low KM grade (HR, 4.324; CI, 1.594-11.733) and high GMS (HR, 6.332; CI, 2.743-14.594) were independent prognostic factors for short OS. Conclusion Histology-based TME scores, including the KM grade, TSP, and GMS, are useful for predicting the survival of patients with resected DBDC.Purpose Computer-aided diagnosis (CAD) systems assist in solving subjective diagnosis problems that typically rely on personal experience. A CAD system has been developed to differentiate malignant thyroid nodules from benign thyroid nodules in ultrasound images based on deep learning methods. The diagnostic performance was compared between the CAD system and the experienced attending radiologists. Methods The ultrasound image dataset for training the CAD system included 651 malignant nodules and 386 benign nodules while the database for testing included 422 malignant nodules and 128 benign nodules. All the nodules were confirmed by pathology results. In the proposed CAD system, a support vector machine (SVM) is used for classification and fused features which combined the deep features extracted by a convolutional neural network (CNN) with the hand-crafted features such as the histogram of oriented gradient (HOG), local binary patterns (LBP), and scale invariant feature transform (SIFT) were obtained. The optimal feature subset was formed by selecting these fused features based on the maximum class separation distance and used as the training sample for the SVM. Results The accuracy, sensitivity, and specificity of the CAD system were 92.5%, 96.4%, and 83.1%, respectively, which were higher than those of the experienced attending radiologists. The areas under the ROC curves of the CAD system and the attending radiologists were 0.881 and 0.819, respectively. Selleckchem Dihydroartemisinin Conclusions The CAD system for thyroid nodules exhibited a better diagnostic performance than experienced attending radiologists. The CAD system could be a reliable supplementary tool to diagnose thyroid nodules using ultrasonography. Macroscopic features in ultrasound images, such as the margins and shape of thyroid nodules, could influence the diagnostic efficiency of the CAD system.