Background. The bile infection may already exist before the administration of an interventional procedure, despite no clinical manifestations of cholangitis detected. Blood cultures remained negative even in more than half of the febrile cases with cholangitis. Risk factors associated with bacterial growth in bile before the intervention are not well defined. To establish the bacterial profiles isolated from the bile samples and to identify risk factors for bacterial colonization in the bile system. Methods. Individuals who underwent endoscopic retrograde cholangiopancreatography (ERCP) interventions were enrolled. Bile samples were aspirated and were immediately transferred into a sterile tube for storage. Results. Positive bile cultures were detected in 363 (38.0%) of 956 patients, including 322 benign diseases and 41 malignances. Of 363 positive cases, 351 (96.7%) were monoinfection and 12 (3.3%) multi-infection. Escherichia coli were the most common Gram-negative bacteria (210, 56.0%), followed by Klebsiella pneumoniae (45, 12.0%). Enterococcus faecalis represented the most common Gram-positive microorganism (19, 5.07%), while Candida albicans (11, 2.93%) were the dominant fungi. Klebsiella pneumoniae were more frequently detected in malignant diseases (P=0.046). Age, previous ERCP history or OLT history, and CBD diameter were independent risk factors for positive cultures (P<0.05) while preoperative jaundice drug therapy was the protective factor for bile infection (P<0.05). Conclusion. Monomicrobial infection was dominant among all infections, and Klebsiella pneumoniae strains were more frequently isolated from patients with malignant diseases. To effectively manage patients who are at a high risk for bile infection, a detailed diagnosis and treatment plan for each case should be prepared.

The ancient Zhenggang landslide (47.5 million m3) represents a potential threat to the construction and safe operation of the proposed Gushui Hydropower Project and to the people living downstream. The landslide was caused by continuous rainfall from October 20 to November 5, 2008, indicating that groundwater aggravated sliding and deformation, and it can be divided into two distinct zones: zone I and zone II. Investigations of the Zhenggang landslide deposits have been conducted for 10 years, but the evolution of the landslide deformation is yet to be revealed. Geological surveys and stability analysis have revealed that the Zhenggang landslide is currently relatively stable and is not sliding. The deformational data for the deep soil layers show that subslide zone I is a translational slide, while subslide zone II is an uplift slide, and zone II is slightly more stable than zone I. Obvious interior deformational failure occurred and was observed in the exploratory adits. The numerical results show that rainfall infiltration is the main factor to induce the revival of ancient landslide, and it is necessary to strengthen the landslide risk assessment and reliability of Zhenggang landslide under the condition of rainfall infiltration. Finally, in order to reduce landslide risks, the local residents living near the landslide mass should be relocated, and measures should be taken to increase slope stability.

Background. Many epidemiological studies have investigated the risk factors for clonorchiasis, but endoscopic findings of this disease in endoscopic retrograde cholangiopancreatography (ERCP) have not been well characterized. In this study, we evaluated clonorchiasis in ERCP in patients with biliary and pancreatic diseases. Methods. This was a retrospective two-center study in hospitalized patients who received ERCP between January 2012 and October 2018. All patients were divided into clonorchiasis and nonclonorchiasis groups. Data were analyzed using univariate analysis and multivariate analyses. Results. A total of 1119 patients were included, and clonorchiasis was diagnosed in 19.2% patients. Detection of Clonorchis sinensis eggs in bile samples was higher than that in fecal samples (85.9% vs. 58.7%; P=0.001). In multivariate analysis, male patients (95% confidence interval (CI): 1.945–4.249, P=0.0001), age≤60 years old (95% CI: 1.212–2.474, P=0.003), patients with papilla fistula (95% CI: 0.081–0.900, P=0.033), and patients with a common bile duct (CBD) diameter<12 mm (95% CI: 1.093–2.130, P=0.013) were associated with clonorchiasis incidence. Nonclonorchiasis endoscopic diagnosis did not significantly correlate with clonorchiasis incidence (P>0.05). Conclusions. The detection of C. sinensis eggs was significantly higher in bile than in fecal samples; thus, bile samples represent a preferable sample for the diagnosis of clonorchiasis in patients with biliary obstruction. We found that male, age≤60 years old, and CBD diameter<12 mm were independent risk factors for clonorchiasis, while papilla fistula was a protective factor.

Objectives. To evaluate the methodology, feasibility, safety, and efficacy of a novel method called over-the-scope clip- (OTSC-) associated endoscopic muscular dissection for small GSMT. Methods. A pilot study on small GSMT   diameter ≤ 1  cm was performed. OTSC-associated endoscopic muscular dissection was based on the requirement of OTSC apparatus and ESD technique; after ligaturing the bottom of small GSMT by OTSC, ESD was performed to resect the tumors, and the wounds of ESD were closed by clips finally. All the patients were followed up for more than 3 months, and the complications during and after OTSC-associated endoscopic muscular dissection were recorded. Results. A total of 7 consecutive patients with small GSMT were included. All tumors were completely dissected without any perforation or infection during and after the procedure in all cases, while three patients had mild abdominal pain, and one experienced postoperative bleeding after the procedure which was treated by the endoscopy with titanium clips. All the patients were followed by endoscopy three months later, all the wounds healed well, and all the OTSCs were still in the gastric wall. Conclusions. OTSC-associated endoscopic muscular dissection as a novel endoscopic interventional therapy should be a convenient, safe, and effective therapy for small GSMT. The short-time outcome is excellent, whereas long-term effect is unclear, and the further follow-up is needed to schedule.