This paper describes a technique to estimate surface-based duct parameters by using a simple ray tracing/correlation method. The approach is novel in that it incorporates the Spearman rank-order correlation scheme bet...This paper describes a technique to estimate surface-based duct parameters by using a simple ray tracing/correlation method. The approach is novel in that it incorporates the Spearman rank-order correlation scheme between the observed surface clutter and the surface ray density for a given propagation path. The simulation results and the real data results both demonstrate the ability of this method to estimate surface-based duct parameters. Compared with the results obtained by a modified genetic algorithm combined with the parabolic wave equation, the results retrieved from the ray tracing/correlation scheme show a minor reduction in accuracy but a great improvement on computation time. Therefore the ray tracing/correlation method might be used as a precursor to more sophisticated and slower techniques, such as genetic algorithm and particle filters, by narrowing the parameter search space and providing a comprehensive and more efficient estimation algorithm.展开更多
BACKGROUND Successful aging(SA)refers to the ability to maintain high levels of physical,cognitive,psychological,and social engagement in old age,with high cognitive function being the key to achieving SA.AIM To explo...BACKGROUND Successful aging(SA)refers to the ability to maintain high levels of physical,cognitive,psychological,and social engagement in old age,with high cognitive function being the key to achieving SA.AIM To explore the potential characteristics of the brain network and functional connectivity(FC)of SA.METHODS Twenty-six SA individuals and 47 usual aging individuals were recruited from community-dwelling elderly,which were taken the magnetic resonance imaging scan and the global cognitive function assessment by Mini Mental State Examination(MMSE).The resting state-functional magnetic resonance imaging data were preprocessed by DPABISurf,and the brain functional network was conducted by DPABINet.The support vector machine model was constructed with altered functional connectivities to evaluate the identification value of SA.RESULTS The results found that the 6 inter-network FCs of 5 brain networks were significantly altered and related to MMSE performance.The FC of the right orbital part of the middle frontal gyrus and right angular gyrus was mostly increased and positively related to MMSE score,and the FC of the right supramarginal gyrus and right temporal pole:Middle temporal gyrus was the only one decreased and negatively related to MMSE score.All 17 significantly altered FCs of SA were taken into the support vector machine model,and the area under the curve was 0.895.CONCLUSION The identification of key brain networks and FC of SA could help us better understand the brain mechanism and further explore neuroimaging biomarkers of SA.展开更多
Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related c...Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related complications.We aimed to develop an artificial intelligence(AI)model for stent length selection during ERCP.Methods:Images of the patients who underwent ERCP and were diagnosed with CBD strictures were collected.Training involved identifying and delineating the duodenoscope,CBD and guidewire,calculating the pixel distance of the target guidewire and determining the required biliary stent length based on the diameter of the duodenoscope.The performance of the model,accuracy for length calculation and the assistance for endoscopists were validated using the testing set.Results:A total of 794 images from 431 patients were included and data augmentation was conducted.The mean intersection over union(mIoU)for duodenoscope,CBD and guidewire were 90.46%,84.79%and 84.64%,respectively.The accuracy in identifying the strictures was 97.58%(121/124).The accuracy for stent length calculation achieved 85.95%(104/121)with an error margin of±1 cm.The mean absolute error(MAE)and mean relative error(MRE)of the AI model was 0.81 cm and 0.13,respectively.The AI model could reduce approximately 202 mGycm^(2)of the radiation exposure for each patient.It significantly improved both MAE and MRE for less experienced endoscopists(P=0.01 and P=0.02,respectively).Conclusions:The AI model could accurately identify duodenoscope,CBD and guidewire,enabling accurate strictures identification and stent length selection.展开更多
AIM:To assess the success rate of lacrimal sac hydrostatic pressure application(HPA)maneuver,a conservative office procedure for treatment of congenital nasolacrimal duct obstruction(CNLDO).METHODS:The medical records...AIM:To assess the success rate of lacrimal sac hydrostatic pressure application(HPA)maneuver,a conservative office procedure for treatment of congenital nasolacrimal duct obstruction(CNLDO).METHODS:The medical records of pediatric patients,36mo old or younger,diagnosed with CNLDO between the years 2016-2022,were retrospectively reviewed.In all children,HPA was performed by a pediatric ophthalmologist.Success was defined as the resolution of epiphora and discharge within 48h of the intervention.RESULTS:A total of 281 eyes(194 patients)with CNLDO underwent HPA.Follow-up data were available for 261 eyes(179 patients,50.3%male)and these patients were included in the analysis.The mean follow-up time was 11.6±13mo.Ninety-seven patients(54.2%)had unilateral nasolacrimal duct obstruction,while 82 patients(45.8%)had bilateral CNLDO.The mean age at the time of HPA was 5.8±5.9mo.Complete resolution of symptoms was achieved in 102(39.1%)eyes.Patients 6mo old or younger at the time of HPA had a significantly higher success rate compared to patients older than 6mo(43.7%vs 30.9%,P=0.04).Younger age at the time of pressure application was associated with a higher resolution rate of CNLDO(OR 0.93,P=0.004).Sex assigned at birth,prematurity,laterality of the obstruction and type of symptoms(epiphora,discharge)were not correlated with success.A second HPA was performed in 46 eyes,with resolution of symptoms in 12 eyes(26.1%).CONCLUSION:Hydrostatic pressure applied on the lacrimal sac by an experienced ophthalmologist or an experienced pediatrician may be an effective treatment for CNLDO.We recommend HPA as an initial active conservative approach in all pediatric patients with CNLDO,especially those younger than 6mo.展开更多
Recent research has highlighted structural and functional abnormalities in the cerebral cortex of patients with premature ejaculation(PE).These anomalies could play a pivotal role in the physiological mechanisms under...Recent research has highlighted structural and functional abnormalities in the cerebral cortex of patients with premature ejaculation(PE).These anomalies could play a pivotal role in the physiological mechanisms underlying PE.This study leveraged functional magnetic resonance imaging(fMRI),a noninvasive technique,to explore these neural mechanisms.We conducted resting-state fMRI scans on 36 PE patients and 22 healthy controls(HC),and collected data on Premature Ejaculation Diagnostic Tool(PEDT)scores and intravaginal ejaculation latency time(IELT).Employing a surface-based regional homogeneity(ReHo)approach,we analyzed local neural synchronous spontaneous activity,diverging from previous studies that utilized a volume-based ReHo method.Areas with significant ReHo differences between PE and HC groups underwent surface-based functional connectivity(FC)analysis.Significant discrepancies in ReHo and FC across the cortical surface were observed in the PE cohort.Notably,PE patients exhibited decreased ReHo in the left triangular inferior frontal gyrus and enhanced ReHo in the right middle frontal gyrus.The latter showed heightened connectivity with the left lingual gyrus and the right orbital superior frontal gyrus.Furthermore,a correlation between ReHo and FC values with PEDT scores and IELT was found in the PE group.Our findings,derived from surface-based fMRI data,underscore specific brain regions linked to the neurobiological underpinnings of PE.展开更多
Pain is one of the manifestations of hip disorder and has been proven to lead to the remodeling of somatotopic map plasticity in the cortex.However,most studies are volume-based which may lead to inaccurate anatomical...Pain is one of the manifestations of hip disorder and has been proven to lead to the remodeling of somatotopic map plasticity in the cortex.However,most studies are volume-based which may lead to inaccurate anatomical positioning of functional data.The methods that work on the cortical surface may be more sensitive than those using the full brain volume and thus be more suitable for map plasticity study.In this prospective cross-sectional study performed in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,China,20 patients with osteonecrosis of the femoral head(12 males and 8 females,aged 56.80±13.60 years)and 20 healthy controls(9 males and 11 females,aged 54.56±10.23 years)were included in this study.Data of resting-state functional magnetic resonance imaging were collected.The results revealed that compared with healthy controls,compared with the healthy controls,patients with osteonecrosis of the femoral head(ONFH)showed significantly increased surface-based regional homogeneity(Re Ho)in areas distributed mainly in the left dorsolateral prefrontal cortex,frontal eye field,right frontal eye field,and the premotor cortex and decreased surface-based Re Ho in the right primary motor cortex and primary sensory cortex.Regions showing significant differences in surfacebased Re Ho values between the healthy controls and patients with ONFH were defined as the regions of interests.Seed-based functional connectivity was performed to investigate interregional functional synchronization.When the areas with decreased surface-based Re Ho in the frontal eye field and right premotor cortex were used as the regions of interest,compared with the healthy controls,the patients with ONFH displayed increased functional connectivity in the right middle frontal cortex and right inferior parietal cortex and decreased functional connectivity in the right precentral cortex and right middle occipital cortex.Compared with healthy controls,patients with ONFH showed significantly decreased cortical thickness in the para-insular area,posterior insular area,anterior superior temporal area,frontal eye field and supplementary motor cortex and reduced volume of subcortical gray matter nuclei in the right nucleus accumbens.These findings suggest that hip disorder patients showed cortical plasticity changes,mainly in sensorimotor-and pain-related regions.This study was approved by the Medical Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine(approval No.2018-041)on August 1,2018.展开更多
The surface-based DNA computing is one of the methods of DNA computing which uses DNA strands immobilized on a solid surface. In this paper, we applied surface-based DNA computing for solving the dominating set proble...The surface-based DNA computing is one of the methods of DNA computing which uses DNA strands immobilized on a solid surface. In this paper, we applied surface-based DNA computing for solving the dominating set problem. At first step, surface-based DNA solution space was constructed by using appropriate DNA strands. Then, by application of a DNA parallel algorithm, dominating set problem was resolved in polynomial time.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who ex...BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.展开更多
·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case gro...·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.展开更多
During the train meeting events,train equipment compartments are exposed to the worst pressure changes,potentially affecting the ventilation performance of equipment,particularly for electrical facilities equipped wit...During the train meeting events,train equipment compartments are exposed to the worst pressure changes,potentially affecting the ventilation performance of equipment,particularly for electrical facilities equipped with independent air ducts.In this paper,a two-step method is used for numerical computation:(1)obtaining the temporal and spatial transient node data of the flow field sections during the train-passing simulation and(2)using the data as the input data for the equipment compartment simulation.In addition,this paper also compares the difference in equipment ventilation between the single-train and trainpassing scenarios in real vehicle tests.The results indicate that the primary factors influencing ventilation effectiveness are the aerodynamic compression and deceleration of airflow induced by the other train's nose,as well as the instability of the external flow field in the wake of the other train.During train crossing,the air is forced into the air duct,with a maximum ratio of the airflow in-duct to the airflow out-duct reaching 3.2.The average mass flow falls below the rated mass flow for the converter.Compared to the rated air volume of converter,the maximum suppression rates obtained from testing and simulation are-24.5%and-16.8%,respectively.Compared to the single-train operation,the maximum suppression rates obtained from testing and simulation are-15%and-18%,respectively.These findings provide valuable insights into the design and operation of high-speed trains.展开更多
Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-ca...Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].展开更多
BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
Collecting duct carcinoma (CDC), or Bellini duct carcinoma, is a rare and aggressive subtype of renal cell carcinoma, accounting for 0.2% - 1% of cases. It often presents at an advanced stage with nonspecific symptoms...Collecting duct carcinoma (CDC), or Bellini duct carcinoma, is a rare and aggressive subtype of renal cell carcinoma, accounting for 0.2% - 1% of cases. It often presents at an advanced stage with nonspecific symptoms, requiring histopathology for diagnosis. Surgery remains the standard of care for localized disease, serving both diagnostic and therapeutic purposes, though adjuvant chemotherapy has shown limited efficacy. In metastatic CDC, the gemcitabine-cisplatin regimen is commonly used due to its resemblance to urothelial cancer and supportive data from prospective studies. Newer therapies offer promise in advanced cases. Immune checkpoint inhibitors, such as nivolumab alone or with ipilimumab, have shown benefits in patients with high PD-L1 expression. Targeted therapies like cabozantinib demonstrated efficacy and safety as first-line treatments in phase II trials, while sunitinib and sorafenib have shown responses in various case reports and cohorts. However, combining chemotherapy with bevacizumab did not improve outcomes in phase II trials. Despite therapeutic advances in urothelial cancers and clear cell renal tumors, the CDC entity remains a challenging malignancy, emphasizing the need for continued research to understand the true efficacy of treatment and to prolong survival in advanced disease.展开更多
BACKGROUND The current surgical treatments for bile duct stones(BDSs)demonstrate suboptimal efficacy,warranting further exploration of superior therapies or improvement of existing surgical protocols.AIM To assess the...BACKGROUND The current surgical treatments for bile duct stones(BDSs)demonstrate suboptimal efficacy,warranting further exploration of superior therapies or improvement of existing surgical protocols.AIM To assess the therapeutic efficacy and safety profiles of endoscopic retrograde cholangiopancreatography(ERCP)vs common bile duct exploration(CBDE)in BDS treatment.METHODS This study enrolled 103 consecutive patients with BDSs treated at the First People’s Hospital of Changde from January 2024 to January 2025,with 53 patients undergoing ERCP(ERCP group)and 50 receiving conventional CBDE(CBDE group).Comprehensive comparative analyses were conducted across multiple parameters,including clinical efficacy,surgical success rate,safety(bile leakage incidence,surgical site infection,acute pancreatitis,and acute cholangitis),postoperative biochemical markers(total bilirubin and serum amylase),surgeryrelated metrics(stone removal time,procedure duration,intraoperative blood loss,and hospitalization time),and postoperative recovery indicators(time to intestinal recovery,jaundice resolution,biliary drainage removal,and postoperative activity recovery).RESULTS The ERCP group demonstrated markedly superior overall efficacy than the CBDE group,with similar surgical success rates and comparable stone removal durations.Importantly,patients undergoing ERCP experienced fewer complications overall,required less operative time,had minimal intraoperative blood loss,and needed shorter hospitalization periods.Recovery parameters such as bowel function recovery,jaundice resolution,biliary stent removal,and normal activity resumption,were significantly improved in the ERCP group.Both groups demonstrated substantial postoperative reductions in total bilirubin and amylase,with no significant intergroup differences.CONCLUSION ERCP demonstrates effectiveness and safety in managing BDSs,thereby providing notable clinical benefits that support its broader implementation in medical practice.展开更多
BACKGROUND Intraoperative and postoperative biliary injuries remain significant complications of laparoscopic common bile duct exploration(LCBDE).Indocyanine green(ICG)has been shown to significantly reduce injuries c...BACKGROUND Intraoperative and postoperative biliary injuries remain significant complications of laparoscopic common bile duct exploration(LCBDE).Indocyanine green(ICG)has been shown to significantly reduce injuries caused by intraoperative operational errors.We found that the J-tube can reduce postoperative strictures and injuries to the common bile duct.At this moment,we aim to analyze and compare the complications,efficacy,short-term outcomes,and feasibility of these two adjunctive tools for LCBDE.AIM To evaluate the efficacy of ICG fluorescence imaging In LCBDE and J-tube drainage for patients with common bile duct stones.METHODS We retrospectively collected the clinical case data of patients who were treated at the Hepatobiliary Surgery Department of the Third People’s Hospital of Nantong,affiliated with Nantong University,from January 2016 to January 2021 due to gallbladder stones with choledocholithiasis and who underwent LCBDE combined with a primary suture and either J-tube or T-tube drainage.The patients were divided into groups:Traditional white-light laparoscopy+T-tube group(WL+T-tube),traditional WL+J-tube group,fluorescent laparoscopy+T-tube group(ICG+T-tube)and fluorescent laparoscopy+J-tube group(ICG+J-tube).The preoperative and postoperative clinical case data,laboratory examination data,and intraoperative and postoperative complications(including postoperative bile leakage,electrolyte disturbances,biliary peritonitis,and postoperative infections)and other relevant indicators were compared.RESULTS A total of 198 patients(112 males and 86 females)were included in the study,with 74 patients in the WL+T-tube,47 in the WL+J-tube,42 in the ICG+T-tube,and 35 in the ICG+J-tube.Compared with the other groups,the ICG+J had significantly shorter operation time(114 minutes,P=0.001),less blood loss(42 mL,P=0.02),shorter postoperative hospital stays(7 days,P=0.038),and lower surgical costs(China yuan 30178,P=0.001).Furthermore,patients were subdivided into two groups based on whether a T-tube or J-tube was placed during the surgery.By the third postoperative day,the aspartate transaminase,glutamic pyruvic transaminase,total bilirubin,and direct bilirubin levels were lower in the J-tube group than in the T-tube group(P<0.001).At last,follow-up observations showed that the incidence of biliary strictures at three months postoperatively was significantly lower in the J-tube group than in the T-tube group(P=0.002).CONCLUSION ICG fluorescence imaging in laparoscopic cholecystectomy with common bile duct exploration and J-tube drainage facilitates rapid identification of biliary anatomy and variations,reducing intraoperative bile duct injury,blood loss,surgery duration,and postoperative bile duct stenosis rates,supporting its clinical adoption.展开更多
BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is cruc...BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.AIM To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC,with a focus on strict adherence to indications.METHODS Clinical data of 106 cases undergoing LCBDE+PDC in the Hepatobiliary and Pancreatic Surgery Department(Division 1)of Chuzhou First People’s Hospital from April 2019 to March 2024 were collected.Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage.The change in surgical time was analyzed using the cumulative summation(CUSUM)method,and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.RESULTS Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage(P<0.05).The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage(P<0.05),with statistical significance.The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve(P=0.023).CONCLUSION With a good assessment of duodenal papilla sphincter function,unobstructed bile-pancreatic duct convergence,exact stone clearance,and sufficient surgical experience to complete the learning curve,PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.展开更多
BACKGROUND At present,there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)for older patients with choledocholithiasis.AIM To identify the potential risk fac...BACKGROUND At present,there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)for older patients with choledocholithiasis.AIM To identify the potential risk factors for bile leakage after LCBDE in older patients.METHODS A retrospective,single-center observational analysis was performed on patients aged≥70 years with choledocholithiasis treated by LCBDE who were admitted to our center between January 2011 and August 2022.The included patients were divided into non-bile leakage and bile leakage groups.Risk factors were determined by analyzing the observation indicators.RESULTS Seventy older patients with choledocholithiasis who underwent LCBDE were included.Univariate analysis showed that positive culture of bile bacteria was a risk factor for bile leakage after LCBDE(P<0.05).We further analyzed the bile bacteria,and univariate analysis showed that Enterococcus faecalis(E.faecalis)(P<0.05)and Pseudomonas aeruginosa(P<0.05)were associated with an increased risk of postoperative bile leakage in older patients(P<0.05).Multivariate analysis showed that E. faecalis was an independent risk factor for postoperative bile leakage in older patients (P < 0.05). Theresults of antibiotic sensitivity analysis showed that E. faecalis had 100% susceptibility to penicillin, ampicillin,linezolid, vancomycin, and furantoin.CONCLUSIONE. faecalis-associated biliary tract infection is an independent risk factor for bile leakage after LCBDE in olderpatients with choledocholithiasis. We suggest coverage with antibiotics to which E. faecalis is sensitive.展开更多
BACKGROUND Esophageal submucosal gland duct adenoma(ESGDA)is very rare,and easily diagnosed as adenocarcinoma.CASE SUMMARY A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallo...BACKGROUND Esophageal submucosal gland duct adenoma(ESGDA)is very rare,and easily diagnosed as adenocarcinoma.CASE SUMMARY A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallowing for 10 days.Digestive endoscopy revealed a polypoid bulge at the esophago-gastric junction,which was resected by endoscopic submucosal dissection(ESD).Routine pathological examination showed intestinal metaplasia of the glandular epithelium on the mucosal surface,with serous tumor-like complex glands in the submucosa which showing significant hyperplasia.This initially diagnosis was early gastric adenocarcinoma.However,we still observed a few points that did not meet the criteria for cancer such as lack of malignant features.Following multidisciplinary discussion and consultation with the experienced specialist pathologists,we finally diagnosed the lesion as a rare ESGDA by further immunohistochemistry.The follow-up examination results for the patient were satisfactory,with no evidence of tumor recurrence.And we summarize the ESGDAs reported in the literature,aiming to enhance understanding of this tumor type.CONCLUSION ESGDA is a benign tumor that can be cured by ESD.Accurate diagnosis can prevent unnecessary extensive therapeutic interventions.展开更多
The authors introduce a new magnetic resonance cholangiopancreatography(MRCP)radiologic feature,the“ice-breaking sign”(IBS),and present a retrospective case-control study comparing patients with common bile duct sto...The authors introduce a new magnetic resonance cholangiopancreatography(MRCP)radiologic feature,the“ice-breaking sign”(IBS),and present a retrospective case-control study comparing patients with common bile duct stones who exhibit the IBS with a control group without this sign.The two groups were matched using a propensity score based on patient age and sex.However,the matching process did not account for the size of the choledocholithiasis,which may represent a significant confounding factor.Both groups were not homogeneous.The authors advocate for the use of MRCP as the primary diagnostic tool to guide the decision.However,in clinical practice,MRCP availability is often limited,particularly when compared to endoscopic ultrasound,which may be more available.The authors compared the clinical course and therapeutic responses to cholangiopancreatography(ERCP)and laparoscopic common bile duct exploration(LCBDE)between the two groups.The results demonstrated a markedly low ERCP success rate in both the study and control,falling below international standards,whereas the success rate of LCBDE was only slightly reduced.Despite the study’s li-mitations and potential biases,the authors conclude that IBS is a valuable predictor for treatment planning and suggest that LCBDE should be considered the first-line approach.Despite its growing acceptance,LCBDE remains infeasible in many hospitals due to the steep learning curve.展开更多
基金Project supported by the National Natural Science Foundation of China (Grant No. 40775025)
文摘This paper describes a technique to estimate surface-based duct parameters by using a simple ray tracing/correlation method. The approach is novel in that it incorporates the Spearman rank-order correlation scheme between the observed surface clutter and the surface ray density for a given propagation path. The simulation results and the real data results both demonstrate the ability of this method to estimate surface-based duct parameters. Compared with the results obtained by a modified genetic algorithm combined with the parabolic wave equation, the results retrieved from the ray tracing/correlation scheme show a minor reduction in accuracy but a great improvement on computation time. Therefore the ray tracing/correlation method might be used as a precursor to more sophisticated and slower techniques, such as genetic algorithm and particle filters, by narrowing the parameter search space and providing a comprehensive and more efficient estimation algorithm.
基金Supported by the Wuxi Municipal Health Commission Major Project,No.Z202107。
文摘BACKGROUND Successful aging(SA)refers to the ability to maintain high levels of physical,cognitive,psychological,and social engagement in old age,with high cognitive function being the key to achieving SA.AIM To explore the potential characteristics of the brain network and functional connectivity(FC)of SA.METHODS Twenty-six SA individuals and 47 usual aging individuals were recruited from community-dwelling elderly,which were taken the magnetic resonance imaging scan and the global cognitive function assessment by Mini Mental State Examination(MMSE).The resting state-functional magnetic resonance imaging data were preprocessed by DPABISurf,and the brain functional network was conducted by DPABINet.The support vector machine model was constructed with altered functional connectivities to evaluate the identification value of SA.RESULTS The results found that the 6 inter-network FCs of 5 brain networks were significantly altered and related to MMSE performance.The FC of the right orbital part of the middle frontal gyrus and right angular gyrus was mostly increased and positively related to MMSE score,and the FC of the right supramarginal gyrus and right temporal pole:Middle temporal gyrus was the only one decreased and negatively related to MMSE score.All 17 significantly altered FCs of SA were taken into the support vector machine model,and the area under the curve was 0.895.CONCLUSION The identification of key brain networks and FC of SA could help us better understand the brain mechanism and further explore neuroimaging biomarkers of SA.
基金supported by grants from the Taishan Scholars Program of Shandong Province(tsqn202312333)the National Natural Science Foundation of China(82470695).
文摘Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related complications.We aimed to develop an artificial intelligence(AI)model for stent length selection during ERCP.Methods:Images of the patients who underwent ERCP and were diagnosed with CBD strictures were collected.Training involved identifying and delineating the duodenoscope,CBD and guidewire,calculating the pixel distance of the target guidewire and determining the required biliary stent length based on the diameter of the duodenoscope.The performance of the model,accuracy for length calculation and the assistance for endoscopists were validated using the testing set.Results:A total of 794 images from 431 patients were included and data augmentation was conducted.The mean intersection over union(mIoU)for duodenoscope,CBD and guidewire were 90.46%,84.79%and 84.64%,respectively.The accuracy in identifying the strictures was 97.58%(121/124).The accuracy for stent length calculation achieved 85.95%(104/121)with an error margin of±1 cm.The mean absolute error(MAE)and mean relative error(MRE)of the AI model was 0.81 cm and 0.13,respectively.The AI model could reduce approximately 202 mGycm^(2)of the radiation exposure for each patient.It significantly improved both MAE and MRE for less experienced endoscopists(P=0.01 and P=0.02,respectively).Conclusions:The AI model could accurately identify duodenoscope,CBD and guidewire,enabling accurate strictures identification and stent length selection.
文摘AIM:To assess the success rate of lacrimal sac hydrostatic pressure application(HPA)maneuver,a conservative office procedure for treatment of congenital nasolacrimal duct obstruction(CNLDO).METHODS:The medical records of pediatric patients,36mo old or younger,diagnosed with CNLDO between the years 2016-2022,were retrospectively reviewed.In all children,HPA was performed by a pediatric ophthalmologist.Success was defined as the resolution of epiphora and discharge within 48h of the intervention.RESULTS:A total of 281 eyes(194 patients)with CNLDO underwent HPA.Follow-up data were available for 261 eyes(179 patients,50.3%male)and these patients were included in the analysis.The mean follow-up time was 11.6±13mo.Ninety-seven patients(54.2%)had unilateral nasolacrimal duct obstruction,while 82 patients(45.8%)had bilateral CNLDO.The mean age at the time of HPA was 5.8±5.9mo.Complete resolution of symptoms was achieved in 102(39.1%)eyes.Patients 6mo old or younger at the time of HPA had a significantly higher success rate compared to patients older than 6mo(43.7%vs 30.9%,P=0.04).Younger age at the time of pressure application was associated with a higher resolution rate of CNLDO(OR 0.93,P=0.004).Sex assigned at birth,prematurity,laterality of the obstruction and type of symptoms(epiphora,discharge)were not correlated with success.A second HPA was performed in 46 eyes,with resolution of symptoms in 12 eyes(26.1%).CONCLUSION:Hydrostatic pressure applied on the lacrimal sac by an experienced ophthalmologist or an experienced pediatrician may be an effective treatment for CNLDO.We recommend HPA as an initial active conservative approach in all pediatric patients with CNLDO,especially those younger than 6mo.
基金This work was financially supported by the National Natural Science Foundation of China(grant No.82001793)Social Development Project of Science and Technology in Jiangsu Province(grant No.BE2019606)。
文摘Recent research has highlighted structural and functional abnormalities in the cerebral cortex of patients with premature ejaculation(PE).These anomalies could play a pivotal role in the physiological mechanisms underlying PE.This study leveraged functional magnetic resonance imaging(fMRI),a noninvasive technique,to explore these neural mechanisms.We conducted resting-state fMRI scans on 36 PE patients and 22 healthy controls(HC),and collected data on Premature Ejaculation Diagnostic Tool(PEDT)scores and intravaginal ejaculation latency time(IELT).Employing a surface-based regional homogeneity(ReHo)approach,we analyzed local neural synchronous spontaneous activity,diverging from previous studies that utilized a volume-based ReHo method.Areas with significant ReHo differences between PE and HC groups underwent surface-based functional connectivity(FC)analysis.Significant discrepancies in ReHo and FC across the cortical surface were observed in the PE cohort.Notably,PE patients exhibited decreased ReHo in the left triangular inferior frontal gyrus and enhanced ReHo in the right middle frontal gyrus.The latter showed heightened connectivity with the left lingual gyrus and the right orbital superior frontal gyrus.Furthermore,a correlation between ReHo and FC values with PEDT scores and IELT was found in the PE group.Our findings,derived from surface-based fMRI data,underscore specific brain regions linked to the neurobiological underpinnings of PE.
基金supported by National Key R&D Program of China,No.2018YFC2001600(to JGX)the National Natural Science Foundation of China,Nos.81802249(to XYH),81871836(to MXZ)+4 种基金a grant from Shanghai Science and Technology Committee of China,Nos.18511108300(to JGX),18441903903900(to XYH),18441903800(to MXZ)Three-Year Action Plan for Traditional Chinese Medicine Development from Shanghai Municipal Health Commission of China,No.ZY(2018-2020)-ZWB-1001-CPJS49(to BL)ZY(2018-2020)-RCPY-3007(to JM)Traditional Chinese Medicine Diagnosis and Treatment Technology Improvement Project from Shanghai Municipal Commission of Health and Family Planning of China,No.Zyjx-2017006(to BL)Special Project of Postgraduate Innovation Training of China,No.A1-GY20-204-0107(to JM)。
文摘Pain is one of the manifestations of hip disorder and has been proven to lead to the remodeling of somatotopic map plasticity in the cortex.However,most studies are volume-based which may lead to inaccurate anatomical positioning of functional data.The methods that work on the cortical surface may be more sensitive than those using the full brain volume and thus be more suitable for map plasticity study.In this prospective cross-sectional study performed in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,China,20 patients with osteonecrosis of the femoral head(12 males and 8 females,aged 56.80±13.60 years)and 20 healthy controls(9 males and 11 females,aged 54.56±10.23 years)were included in this study.Data of resting-state functional magnetic resonance imaging were collected.The results revealed that compared with healthy controls,compared with the healthy controls,patients with osteonecrosis of the femoral head(ONFH)showed significantly increased surface-based regional homogeneity(Re Ho)in areas distributed mainly in the left dorsolateral prefrontal cortex,frontal eye field,right frontal eye field,and the premotor cortex and decreased surface-based Re Ho in the right primary motor cortex and primary sensory cortex.Regions showing significant differences in surfacebased Re Ho values between the healthy controls and patients with ONFH were defined as the regions of interests.Seed-based functional connectivity was performed to investigate interregional functional synchronization.When the areas with decreased surface-based Re Ho in the frontal eye field and right premotor cortex were used as the regions of interest,compared with the healthy controls,the patients with ONFH displayed increased functional connectivity in the right middle frontal cortex and right inferior parietal cortex and decreased functional connectivity in the right precentral cortex and right middle occipital cortex.Compared with healthy controls,patients with ONFH showed significantly decreased cortical thickness in the para-insular area,posterior insular area,anterior superior temporal area,frontal eye field and supplementary motor cortex and reduced volume of subcortical gray matter nuclei in the right nucleus accumbens.These findings suggest that hip disorder patients showed cortical plasticity changes,mainly in sensorimotor-and pain-related regions.This study was approved by the Medical Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine(approval No.2018-041)on August 1,2018.
文摘The surface-based DNA computing is one of the methods of DNA computing which uses DNA strands immobilized on a solid surface. In this paper, we applied surface-based DNA computing for solving the dominating set problem. At first step, surface-based DNA solution space was constructed by using appropriate DNA strands. Then, by application of a DNA parallel algorithm, dominating set problem was resolved in polynomial time.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
文摘BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.
文摘·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.
基金support by Technology R&D Program of China State Railway Group Co.,Ltd(Grant number N2022J013)the Hunan Provincial Innovation Foundation for Postgraduate(Grant number CX20220279)+1 种基金the Fundamental Research Funds for the Central Universities of Central South University(Grant number 2022ZZTS0193)China Scholarship Council(202106370112)。
文摘During the train meeting events,train equipment compartments are exposed to the worst pressure changes,potentially affecting the ventilation performance of equipment,particularly for electrical facilities equipped with independent air ducts.In this paper,a two-step method is used for numerical computation:(1)obtaining the temporal and spatial transient node data of the flow field sections during the train-passing simulation and(2)using the data as the input data for the equipment compartment simulation.In addition,this paper also compares the difference in equipment ventilation between the single-train and trainpassing scenarios in real vehicle tests.The results indicate that the primary factors influencing ventilation effectiveness are the aerodynamic compression and deceleration of airflow induced by the other train's nose,as well as the instability of the external flow field in the wake of the other train.During train crossing,the air is forced into the air duct,with a maximum ratio of the airflow in-duct to the airflow out-duct reaching 3.2.The average mass flow falls below the rated mass flow for the converter.Compared to the rated air volume of converter,the maximum suppression rates obtained from testing and simulation are-24.5%and-16.8%,respectively.Compared to the single-train operation,the maximum suppression rates obtained from testing and simulation are-15%and-18%,respectively.These findings provide valuable insights into the design and operation of high-speed trains.
文摘Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
文摘Collecting duct carcinoma (CDC), or Bellini duct carcinoma, is a rare and aggressive subtype of renal cell carcinoma, accounting for 0.2% - 1% of cases. It often presents at an advanced stage with nonspecific symptoms, requiring histopathology for diagnosis. Surgery remains the standard of care for localized disease, serving both diagnostic and therapeutic purposes, though adjuvant chemotherapy has shown limited efficacy. In metastatic CDC, the gemcitabine-cisplatin regimen is commonly used due to its resemblance to urothelial cancer and supportive data from prospective studies. Newer therapies offer promise in advanced cases. Immune checkpoint inhibitors, such as nivolumab alone or with ipilimumab, have shown benefits in patients with high PD-L1 expression. Targeted therapies like cabozantinib demonstrated efficacy and safety as first-line treatments in phase II trials, while sunitinib and sorafenib have shown responses in various case reports and cohorts. However, combining chemotherapy with bevacizumab did not improve outcomes in phase II trials. Despite therapeutic advances in urothelial cancers and clear cell renal tumors, the CDC entity remains a challenging malignancy, emphasizing the need for continued research to understand the true efficacy of treatment and to prolong survival in advanced disease.
文摘BACKGROUND The current surgical treatments for bile duct stones(BDSs)demonstrate suboptimal efficacy,warranting further exploration of superior therapies or improvement of existing surgical protocols.AIM To assess the therapeutic efficacy and safety profiles of endoscopic retrograde cholangiopancreatography(ERCP)vs common bile duct exploration(CBDE)in BDS treatment.METHODS This study enrolled 103 consecutive patients with BDSs treated at the First People’s Hospital of Changde from January 2024 to January 2025,with 53 patients undergoing ERCP(ERCP group)and 50 receiving conventional CBDE(CBDE group).Comprehensive comparative analyses were conducted across multiple parameters,including clinical efficacy,surgical success rate,safety(bile leakage incidence,surgical site infection,acute pancreatitis,and acute cholangitis),postoperative biochemical markers(total bilirubin and serum amylase),surgeryrelated metrics(stone removal time,procedure duration,intraoperative blood loss,and hospitalization time),and postoperative recovery indicators(time to intestinal recovery,jaundice resolution,biliary drainage removal,and postoperative activity recovery).RESULTS The ERCP group demonstrated markedly superior overall efficacy than the CBDE group,with similar surgical success rates and comparable stone removal durations.Importantly,patients undergoing ERCP experienced fewer complications overall,required less operative time,had minimal intraoperative blood loss,and needed shorter hospitalization periods.Recovery parameters such as bowel function recovery,jaundice resolution,biliary stent removal,and normal activity resumption,were significantly improved in the ERCP group.Both groups demonstrated substantial postoperative reductions in total bilirubin and amylase,with no significant intergroup differences.CONCLUSION ERCP demonstrates effectiveness and safety in managing BDSs,thereby providing notable clinical benefits that support its broader implementation in medical practice.
文摘BACKGROUND Intraoperative and postoperative biliary injuries remain significant complications of laparoscopic common bile duct exploration(LCBDE).Indocyanine green(ICG)has been shown to significantly reduce injuries caused by intraoperative operational errors.We found that the J-tube can reduce postoperative strictures and injuries to the common bile duct.At this moment,we aim to analyze and compare the complications,efficacy,short-term outcomes,and feasibility of these two adjunctive tools for LCBDE.AIM To evaluate the efficacy of ICG fluorescence imaging In LCBDE and J-tube drainage for patients with common bile duct stones.METHODS We retrospectively collected the clinical case data of patients who were treated at the Hepatobiliary Surgery Department of the Third People’s Hospital of Nantong,affiliated with Nantong University,from January 2016 to January 2021 due to gallbladder stones with choledocholithiasis and who underwent LCBDE combined with a primary suture and either J-tube or T-tube drainage.The patients were divided into groups:Traditional white-light laparoscopy+T-tube group(WL+T-tube),traditional WL+J-tube group,fluorescent laparoscopy+T-tube group(ICG+T-tube)and fluorescent laparoscopy+J-tube group(ICG+J-tube).The preoperative and postoperative clinical case data,laboratory examination data,and intraoperative and postoperative complications(including postoperative bile leakage,electrolyte disturbances,biliary peritonitis,and postoperative infections)and other relevant indicators were compared.RESULTS A total of 198 patients(112 males and 86 females)were included in the study,with 74 patients in the WL+T-tube,47 in the WL+J-tube,42 in the ICG+T-tube,and 35 in the ICG+J-tube.Compared with the other groups,the ICG+J had significantly shorter operation time(114 minutes,P=0.001),less blood loss(42 mL,P=0.02),shorter postoperative hospital stays(7 days,P=0.038),and lower surgical costs(China yuan 30178,P=0.001).Furthermore,patients were subdivided into two groups based on whether a T-tube or J-tube was placed during the surgery.By the third postoperative day,the aspartate transaminase,glutamic pyruvic transaminase,total bilirubin,and direct bilirubin levels were lower in the J-tube group than in the T-tube group(P<0.001).At last,follow-up observations showed that the incidence of biliary strictures at three months postoperatively was significantly lower in the J-tube group than in the T-tube group(P=0.002).CONCLUSION ICG fluorescence imaging in laparoscopic cholecystectomy with common bile duct exploration and J-tube drainage facilitates rapid identification of biliary anatomy and variations,reducing intraoperative bile duct injury,blood loss,surgery duration,and postoperative bile duct stenosis rates,supporting its clinical adoption.
基金Supported by the Wannan Medical College Teaching Hospital Special Application for Scientific Research,No.WK2023JXYY036the Anhui Provincial Translational Clinical Medical Research Special Application,No.202204295107020062.
文摘BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.AIM To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC,with a focus on strict adherence to indications.METHODS Clinical data of 106 cases undergoing LCBDE+PDC in the Hepatobiliary and Pancreatic Surgery Department(Division 1)of Chuzhou First People’s Hospital from April 2019 to March 2024 were collected.Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage.The change in surgical time was analyzed using the cumulative summation(CUSUM)method,and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.RESULTS Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage(P<0.05).The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage(P<0.05),with statistical significance.The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve(P=0.023).CONCLUSION With a good assessment of duodenal papilla sphincter function,unobstructed bile-pancreatic duct convergence,exact stone clearance,and sufficient surgical experience to complete the learning curve,PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.
基金Supported by the Ke Qiao Science and Technology Plan Projects,No.2022KZ70.
文摘BACKGROUND At present,there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)for older patients with choledocholithiasis.AIM To identify the potential risk factors for bile leakage after LCBDE in older patients.METHODS A retrospective,single-center observational analysis was performed on patients aged≥70 years with choledocholithiasis treated by LCBDE who were admitted to our center between January 2011 and August 2022.The included patients were divided into non-bile leakage and bile leakage groups.Risk factors were determined by analyzing the observation indicators.RESULTS Seventy older patients with choledocholithiasis who underwent LCBDE were included.Univariate analysis showed that positive culture of bile bacteria was a risk factor for bile leakage after LCBDE(P<0.05).We further analyzed the bile bacteria,and univariate analysis showed that Enterococcus faecalis(E.faecalis)(P<0.05)and Pseudomonas aeruginosa(P<0.05)were associated with an increased risk of postoperative bile leakage in older patients(P<0.05).Multivariate analysis showed that E. faecalis was an independent risk factor for postoperative bile leakage in older patients (P < 0.05). Theresults of antibiotic sensitivity analysis showed that E. faecalis had 100% susceptibility to penicillin, ampicillin,linezolid, vancomycin, and furantoin.CONCLUSIONE. faecalis-associated biliary tract infection is an independent risk factor for bile leakage after LCBDE in olderpatients with choledocholithiasis. We suggest coverage with antibiotics to which E. faecalis is sensitive.
文摘BACKGROUND Esophageal submucosal gland duct adenoma(ESGDA)is very rare,and easily diagnosed as adenocarcinoma.CASE SUMMARY A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallowing for 10 days.Digestive endoscopy revealed a polypoid bulge at the esophago-gastric junction,which was resected by endoscopic submucosal dissection(ESD).Routine pathological examination showed intestinal metaplasia of the glandular epithelium on the mucosal surface,with serous tumor-like complex glands in the submucosa which showing significant hyperplasia.This initially diagnosis was early gastric adenocarcinoma.However,we still observed a few points that did not meet the criteria for cancer such as lack of malignant features.Following multidisciplinary discussion and consultation with the experienced specialist pathologists,we finally diagnosed the lesion as a rare ESGDA by further immunohistochemistry.The follow-up examination results for the patient were satisfactory,with no evidence of tumor recurrence.And we summarize the ESGDAs reported in the literature,aiming to enhance understanding of this tumor type.CONCLUSION ESGDA is a benign tumor that can be cured by ESD.Accurate diagnosis can prevent unnecessary extensive therapeutic interventions.
文摘The authors introduce a new magnetic resonance cholangiopancreatography(MRCP)radiologic feature,the“ice-breaking sign”(IBS),and present a retrospective case-control study comparing patients with common bile duct stones who exhibit the IBS with a control group without this sign.The two groups were matched using a propensity score based on patient age and sex.However,the matching process did not account for the size of the choledocholithiasis,which may represent a significant confounding factor.Both groups were not homogeneous.The authors advocate for the use of MRCP as the primary diagnostic tool to guide the decision.However,in clinical practice,MRCP availability is often limited,particularly when compared to endoscopic ultrasound,which may be more available.The authors compared the clinical course and therapeutic responses to cholangiopancreatography(ERCP)and laparoscopic common bile duct exploration(LCBDE)between the two groups.The results demonstrated a markedly low ERCP success rate in both the study and control,falling below international standards,whereas the success rate of LCBDE was only slightly reduced.Despite the study’s li-mitations and potential biases,the authors conclude that IBS is a valuable predictor for treatment planning and suggest that LCBDE should be considered the first-line approach.Despite its growing acceptance,LCBDE remains infeasible in many hospitals due to the steep learning curve.
