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Background CA19–9 is one of the most widely used tumor markers in biliary-pancreatic diseases. The measured value may not factually reflect the genuine CA19–9 level secreted by tumor, which affected by biliary obstruction. There is an urgent need of developing a correction formula of CA19–9 in biliary obstructive patients to guide clinical practice and avoid making improper clinical decision. Methods Clinical characteristics were collected among patients undergoing biliary drainage in our hospital between January 2014 and January 2019. By comparing the malignant and benign patients statistically, dynamic change trend of CA19–9 levels after biliary drainage was obtained. The correction formulas of CA19–9 were generated by means of linear regression. Results 121 patients, including 102 malignant and 19 benign patients, were enrolled in this study. The baseline CA19–9 level of malignant patients is much higher than that of benign patients. Total bilirubin (TB) level was found to be not related with CA19–9 value (p = 0.109). The drop proportion of the average CA19–9 level in the malignant patients (39.2%, IQR -18.4-78.6%) was much lower than that in the benign patients (75.7%, IQR 58.1–86.6%) (p = 0.014). The correction formula, CA19–9True = 0.63 × CA19–9Measured - 20.3 (R2 = 0.693, p<0.001), was generated based on the linear relation between CA19–9 after drainage and CA19–9 before drainage in malignant patients, which had similar diagnostic value with true CA19–9 value. Conclusions Quantitative correction formulas of CA19–9 considering the effect of biliary decompression was first proposed in this study, aiming to provide a more accurate CA19–9 level to make more accurate clinical decision and avoid making improper therapeutic schedule.

Zollinger-Ellison syndrome (ZES) is characterized by gastric acid hypersecretion causing severe recurrent acid-related peptic disease. Excessive secretion of gastrin can now be effectively controlled with powerful proton pump inhibitors, but surgical management to control gastrinoma itself remains controversial. Based on a thorough literature review, we design a surgical algorithm for ZES and list some significant consensus findings and recommendations: (1) For sporadic ZES, surgery should be routinely undertaken as early as possible not only for patients with a precisely localized diagnosis but also for those with negative imaging findings. The surgical approach for sporadic ZES depends on the lesion location (including the duodenum, pancreas, lymph nodes, hepatobiliary tract, stomach, and some extremely rare sites such as the ovaries, heart, omentum, and jejunum). Intraoperative liver exploration and lymphadenectomy should be routinely performed; (2) For multiple endocrine neoplasia type 1-related ZES (MEN1/ZES), surgery should not be performed routinely except for lesions > 2 cm. An attempt to perform radical resection (pancreaticoduodenectomy followed by lymphadenectomy) can be made. The ameliorating effect of parathyroid surgery should be considered, and parathyroidectomy should be performed first before any abdominal surgery for ZES; and (3) For hepatic metastatic disease, hepatic resection should be routinely performed. Currently, liver transplantation is still considered an investigational therapeutic approach for ZES. Well-designed prospective studies are desperately needed to further verify and modify the current considerations.

Additional file 11: Supplementary Table S10. Genotype of strains used in this study.

The aim of the present study was to research the effect of microenvironmental change on epithelial‑mesenchymal transition (EMT) in pancreatic cancer cells and to determine the correlation between E‑cadherin expression and the prognosis of pancreatic cancer patients. We established hypoxic, serum‑deficient and TGF‑β‑induced microenvironment models of pancreatic cancer cells and studied the changes in the mRNA and protein expression of EMT‑related molecules, E‑cadherin and vimentin, using western blot analysis and real‑time PCR. Furthermore, immunohistochemistry was used to investigate E‑cadherin expression in pancreatic cancer tissues, and survival analysis and COX regression analysis were conducted. In pancreatic cancer cells under hypoxic, serum‑starved and TGF‑β‑induced microenvironments, E‑cadherin protein and mRNA levels were significantly decreased (P