Background: Supermarkets are a place visited by individuals with different health conditions daily where microbiological contaminants through touch onto fomites such as trolleys and baskets can be passed on to other p...Background: Supermarkets are a place visited by individuals with different health conditions daily where microbiological contaminants through touch onto fomites such as trolleys and baskets can be passed on to other people hence potentially spreading infectious diseases. This study aimed to investigate the presence of Gram-negative and Gram-positive bacteria on handheld shopping trolleys and baskets and their antimicrobial susceptibility status against commonly used antibiotics in Zambia. Methods: A cross-sectional study was conducted. Trolleys and basket handles were swabbed and standard microbiological methods were used to identify the bacteria and disc diffusion to determine their antimicrobial susceptibility status. Data was collected from December 2021 to April 2022. Data was analysed using IBM Statistical Package for Social Sciences (SPSS) Version 22. Results: Twenty-eight percent of the 200 total samples were found to be culture-positive and predominant isolates were Staphylococcus aureus (17.3%), Pseudomonas species (4.5%), Escherichia coli (2%), Corynebacterium species (2%), Staphylococcus species (1.5%) and Enterobacter aerogenes (0.5%). Staphylococcus aureus showed the most resistance to azithromycin (17%) followed by ciprofloxacin (2.8%), nitrofurantoin (2.8%) and chloramphenicol (2.8%). Escherichia coli showed 100% resistance to amoxicillin, cloxacillin and ampicillin, 75% resistance to ciprofloxacin and the least resistance to azithromycin (25%) while it was susceptible to nitrofurantoin. Staphylococcus species, Corynebacterium species, Enterobacter aerogenes and Pseudomonas species showed no resistance to any antibiotics. Conclusion: The study showed the presence of microorganisms with considerable antimicrobial resistance to antibiotics in Zambia on trolley and basket handles indicating the need for more initiatives to address proper hygiene in public environmental sites for better infection prevention and control.展开更多
Among Chinese woven products, bamboo baskets have the widest of uses. They are light and durable and graceful. Bamboo baskets have been indispensable for hundreds of years in South China. there are large varieties of ...Among Chinese woven products, bamboo baskets have the widest of uses. They are light and durable and graceful. Bamboo baskets have been indispensable for hundreds of years in South China. there are large varieties of bamboo baskets in China, but the best are those made by the local people in eastern Zhejiang Province, especially in Shengxian and Dongyang. These places have a long history in bamboo basket making and work is well-known nationwide. The baskets from there展开更多
Background: Complications after endoscopic retrieval of kidney and ureter stones are obviously related to the size of the stones as well as the experience of the surgeon and other factors. During the procedure it is s...Background: Complications after endoscopic retrieval of kidney and ureter stones are obviously related to the size of the stones as well as the experience of the surgeon and other factors. During the procedure it is sometimes difficult for surgeons to estimate stone size and therefore give prognostic advises. The visual perception of the stone size depends on the shape, colour, distance to the renoscope and dilatation of the ureter. This is the so-called binding problem, because shape, color and direction of motion are processed separately by different population of optical neurons. In order to establish a better prognostic rational especially for less experienced surgeons, we established an intra operative semi-quantitative measurement of the stone size supported by a stone basket. Materials and Methods: We modified the tipped, nitinol stone baskets from the company Urotech with diameters of 2.5, 3.0 and 4 FR. The handle of this basket has a spring mechanism, which automatically closes the basket and provides a predefined fixation force of the stones within the basket. On the handle we established a non-linear scale in mm by grabbing standardized balls or standardized screws. Result: The scales are nonlinear because of the nonlinear relation between the diameter of the stone and the distance of the slider. Also the scales differ in between the basket size, because of the different strain conditions due to the different wire sizes and materials or the spring and basket. Conclusion: This scale could be an important orientation for a surgeon during endourological procedures to estimate stone sizes. After further clinical experience a semi-quantitative visualization like green, yellow and red colors could help to predict potential complications due to large stone sizes. Finally it could bevery interesting for other disciplines like gastroenterology.展开更多
Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controver...Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controversial.This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions.Methods:We compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions.We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital,Naval Medical University between February 2012 and December 2021.After propensity score matching(1:1),101 patients were included in each group.The primary outcome was the rate of pancreatic stone clearance.Secondary outcomes included the rate of adverse events during hospitalization,long-term pain relief,and quality of life after one year follow-up period.Results:The rate of complete clearance was comparable between the two groups(86.1%vs.84.2%,P=0.692).In patients with stones≥2 cm before extracorporeal shock wave lithotripsy(ESWL),the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group[100%(19/19)vs.70.0%(14/20),P=0.031].In the multivariate logistic analysis,ESWL prior to stone extraction was the only independent predictor of complete clearance[with ESWL 58.4%(264/452)vs.without ESWL 41.6%(188/452),odds ratio=2.3,95%confidence interval:1.2–4.3;P=0.013].No significant differences between groups were found regarding the rates of adverse events during hospitalization,quality of life,and pain relief after one year of follow-up.Conclusions:Basket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions.However,the balloon catheter was superior to the basket catheter if the pancreatic stone size was≥2 cm before ESWL.展开更多
Once a mining village,Jingshan in Hangzhou has reinvented itself over the past 20 years as a thriving model of green transformation.STROLLING through a village named Jingshan located in Hangzhou City,east China’s Zhe...Once a mining village,Jingshan in Hangzhou has reinvented itself over the past 20 years as a thriving model of green transformation.STROLLING through a village named Jingshan located in Hangzhou City,east China’s Zhejiang Province,one will notice the image of a“little tea farmer”wearing a bamboo hat and carrying a tea basket in many places.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses ...Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses on the surgical management of key ERCP-related complications:Post-sphincterotomy bleeding,perforations,stent migration-induced perforations,and Dormia basket impaction.Although many complications can be managed endoscopically,surgery remains essential in refractory cases or when less invasive methods fail.Post-sphincterotomy bleeding,although often controlled endoscopically,may necessitate surgical ligation when hemorrhage persists.Perforations,classified by anatomical type,require tailored surgical approaches-primary repair for type I and biliary diversion with defect closure for types II and III.Stent migration-induced perforations,which may lead to peritonitis or abscess formation,often require surgery due to their variable clinical presentation and the lack of standardized management guidelines.Dormia basket impaction,although rare,may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective.Early recognition,multidisciplinary collaboration,and individualized treatment strategies are pivotal in reducing morbidity and mortality.This review underscores evolving surgical approaches,emphasizing the importance of timely,patient-specific decisions to improve outcomes in severe ERCP-related complications.展开更多
For genome mulUplication hepadnaviruses use the transcriptional machinery of the cell that is found within the nucleus. Thus the viral genome has to be transported through the cytoplasm and nuclear pore. The intracyto...For genome mulUplication hepadnaviruses use the transcriptional machinery of the cell that is found within the nucleus. Thus the viral genome has to be transported through the cytoplasm and nuclear pore. The intracytosolic translocation is facilitated by the viral capsid that surrounds the genome and that interacts with cellular microtubules. The subsequent passage through the nuclear pore complexes （NPC） is mediated by the nuclear transport receptors importin α andβ. Importin α binds to the C-terminus of the capsid protein that comprises a nuclear localization signal （NLS）. The exposure of the NLS is regulated and depends upon genome maturation and/or phosphorylation of the capsid protein. As for other karyophilic cargos using this pathway importin α interacts with importin β that facilitates docking of the import complex to the NPC and the passage through the pore. Being a unique strategy, the import of the viral capsid is incomplete in that it becomes arrested inside the nuclear basket, which is a cage-like structure on the karyoplasmic face of the NPC. Presumably only this compartment provides the factors that are required for capsid disassembly and genome release that is restricted to those capsids comprising a mature viral DNA genome.展开更多
Mechanical lithotripsy （ML） is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not...Mechanical lithotripsy （ML） is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no es- tablished endoscopic extraction method for such gi- ant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct （CBD）. Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An at- tempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capturethe stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangio- pancreatography; each of which took 30 rain. No com- plications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones.展开更多
Foreign body ingestion is a common emergency situation in children with one or a few objects having been ingested. Here we report our experience using endo-scopic retrieval in a female centenarian with dyspnea and for...Foreign body ingestion is a common emergency situation in children with one or a few objects having been ingested. Here we report our experience using endo-scopic retrieval in a female centenarian with dyspnea and foreign bodies in the esophagus. She attempted suicide by swallowing 26 coins and two other foreign bodies. A gastroscope was used to remove all foreign bodies in the lower esophagus. In total, 26 coins, one ferrous ring and one cylindrical plastic object were retrieved. To our knowledge, this is the first clinical report on retrieval of so many foreign bodies in a single case.展开更多
BACKGROUND： A previous report has identified a significantly higher sensitivity of cancer detection for dedicated grasping basket than brushing at endoscopic retrograde cholangiopancreato- graphy （ERCP）. This study...BACKGROUND： A previous report has identified a significantly higher sensitivity of cancer detection for dedicated grasping basket than brushing at endoscopic retrograde cholangiopancreato- graphy （ERCP）. This study aimed to compare the diagnostic accuracy of Geenen brush and Dormia basket cytology in the differential diagnosis of bile duct stricture. METHOD： The current study enrolled one hundred and fourteen patients who underwent ERCP with both Geenen brush and Dormia basket cytology for the differential diagnosis of bile duct stricture at our institution between January 2008 and December 2012. RESULTS： We adopted sequential performances of cytologic samplings by using initial Geenen brush and subsequent Dormia basket cytology in 59 patients and initial Dormia basket and subsequent Geenen brush cytology in 55 patients. Presampling balloon dilatations and biliary stentings for the stricture were performed in 17 （14.9%） and 107 patients （93.9%）, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Geenen brush cytology for the diagnosis of malignant bile duct stricture were 75.0%, 100.0%, 100.0%, 66.7% and 83.3%, respectively, and those of Dormia basket cytology were 64.5%, 100.0%, 100.0%, 58.5% and 76.3%, respectively （P=0.347 and 0.827 for sensitivity and accuracy, respectively）. The good and excellent cellular yields （≥grade 2） were obtained by Geenen brush and Dormia basket cytology in 88 （77.2%） and 79 （69.3%） patients, respectively.CONCLUSION： The sensitivity, specificity and accuracy of biliary sampling with a Dormia basket are comparable to those with conventional Geenen brush cytology in the detection of malignant bile duct stricture.展开更多
The treatments for common bile duct (CBD) stones are being continually developed. Impaction of the lithotripsy basket during endoscopic removal of CBD stones was seen in 5.9% patients. We report the case of a 66-yearo...The treatments for common bile duct (CBD) stones are being continually developed. Impaction of the lithotripsy basket during endoscopic removal of CBD stones was seen in 5.9% patients. We report the case of a 66-yearold woman who underwent surgery for the removal of an impacted biliary basket. She was admitted to our hospital with a complaint of right upper abdominal pain. Magnetic resonance cholangiopancreatography revealed a CBD stone (20 mm × 15 mm). We diagnosed her with choledocholithiasis and performed endoscopic retrograde cholangiopancreatography to remove the stone. However, unfortunately, the retrievable basket around the stone became impacted. An endotriptor along with forceps could not be used owing to the entrapment of the basket, and thus we performed urgent surgery. The basket containing the stone was removed through a longitudinal choledochotomy. The wires leading to the basket were cut, and the basket containing the stone was removed via the incision. A T-tube was inserted,and the choledochotomy was closed. The postoperative course was uneventful. In conclusion, if the diameter of a CBD stone is more than 20 mm, then the risk of basket impaction increases, and surgery may be necessary as the initial treatment of the CBD stone.展开更多
The objective of this work is to study the influences of silica supports and PEG additive on the sorption performance of molecular basket sorbent（MBS） for COcapture consisting of polyethylenimine and one of the foll...The objective of this work is to study the influences of silica supports and PEG additive on the sorption performance of molecular basket sorbent（MBS） for COcapture consisting of polyethylenimine and one of the following supports: SBA-15（2-D structure）, TUD-1（3-D sponge-like structure） and fumed silica HS-5（3-D disordered structure）. Effects of the supports regarding pore structures and pore properties, the PEI loading amount as well as the sorption temperature were examined. Furthermore, polyethylene glycol（PEG） was introduced as an additive into the sorbents and its effect was investigated at different PEI loadings and sorption temperatures. The results suggest that the pore properties of MBS（after PEI loading） play a more important role in the COsorption capacity, rather than those of the supports alone.MBS with 3D pore structure exhibits higher COsorption capacity and amine efficiency than those with 2D-structured support. Among the sorbents studied, fumed silica（HS-5） based MBS showed the highest COsorption capacity in the temperature range of 30-95 °C, probably due to its unique interstitial pores formed by the aggregation of polymer-loaded SiOparticles. It was found that the temperature dependence is directly related to the PEI surface coverage layers. The more PEI surface coverage layers, the higher diffusion barrier for COand the stronger temperature dependence of COcapacity. 3D MBS exceeds 2D MBS at the same PEI coverage layers due to lower diffusion barrier. Adding PEG can significantly enhance the COsorption capacity and improve amine efficiency of all MBS, most likely by alleviating the diffusion barrier within PEI bulk layers through the inter-molecular interaction between PEI and PEG.展开更多
AIM:To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography(ERCP) procedure.METHODS: Basket impaction of either classical Dormia basket or mechani...AIM:To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography(ERCP) procedure.METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients.These patients were immediately operated for removal of stone(s) and impacted basket.The postoperative course,length of hospital stay,diameter of the stone,complication and the surgical procedure of the patients were reported retrospectively.RESULTS: Six patients(M/F,0/6) were operated due to impacted basket during ERCP procedure.The mean age of the patients was 64.33 ± 14.41 years.In all cases the surgery was performed immediately after the failed ERCP procedure by making a rightsubcostal incision.The baskets containing the stone were removed through longitudinal choledochotomy with the stone.The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients.All patients were also performed cholecystectomy additionally since they had cholelithiasis.In patients with T-tube placement it was removed on the 13 th day after a normal T-tube cholangiogram.The patients remained stable at postoperative period and discharged without any complication at median 7 d.CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.展开更多
Gamma band oscillation（GBO） and sensory gating（SG） are associated with many cognitive functions.Ketamine induces deficits of GBO and SG in the prefrontal cortex（PFC）. However, the time-courses of the effects of ...Gamma band oscillation（GBO） and sensory gating（SG） are associated with many cognitive functions.Ketamine induces deficits of GBO and SG in the prefrontal cortex（PFC）. However, the time-courses of the effects of different doses of ketamine on GBO power and SG are poorly understood. Studies have indicated that GBO power and SG have a common substrate for their generation and abnormalities. In this study, we found that（1） ketamine administration increased GBO power in the PFC in rats differently in the low-and high-dose groups;（2） auditory SG was significantly lower than baseline in the 30 mg/kg and 60 mg/kg groups, but not in the 15 mg/kg and 120 mg/kg groups; and（3） changes in SG and basal GBO power were significantly correlated in awake rats. These results indicate a relationship between mechanisms underlying auditory SG and GBO power.展开更多
The market trends rapidly changed over the last two decades.The primary reason is the newly created opportunities and the increased number of competitors competing to grasp market share using business analysis techniq...The market trends rapidly changed over the last two decades.The primary reason is the newly created opportunities and the increased number of competitors competing to grasp market share using business analysis techniques.Market Basket Analysis has a tangible effect in facilitating current change in the market.Market Basket Analysis is one of the famous fields that deal with Big Data and Data Mining applications.MBA initially uses Association Rule Learning(ARL)as a mean for realization.ARL has a beneficial effect in providing a plenty benefit in analyzing the market data and understanding customers’behavior.An important motive of using such techniques is maximizing the business profit as well as matching the exact customer needs as closely as possible.In this survey paper,we discussed several applications and methods of MBA based on ARL.Also,we reviewed some association rule learning measurements including trust,lift,leverage,and others.Furthermore,we discuss some open issues and future topics in the area of market basket analysis and association rule learning.展开更多
Fracture of the central lead wire of an impacted basket during a mechanical lithotripsy for large common bile duct(CBD) stones poses a special challenge.Different maneuvers have been described to resolve this problem....Fracture of the central lead wire of an impacted basket during a mechanical lithotripsy for large common bile duct(CBD) stones poses a special challenge.Different maneuvers have been described to resolve this problem.Most techniques require equipment or facilities which may not be readily available in small community hospitals.We present here a similar situation in a patient with a large stone at the level of the cystic duct.Through the duodenoscope,a smaller Dormia basket was introduced into the CBD along the side of the impacted broken basket.The tip of the impacted basket was grasped and,by pulling downwards,the basket was disengaged from the stone.The two baskets were then removed successfully.We suggest this simple technique should be tried initially,before resorting to more advanced procedures.展开更多
文摘Background: Supermarkets are a place visited by individuals with different health conditions daily where microbiological contaminants through touch onto fomites such as trolleys and baskets can be passed on to other people hence potentially spreading infectious diseases. This study aimed to investigate the presence of Gram-negative and Gram-positive bacteria on handheld shopping trolleys and baskets and their antimicrobial susceptibility status against commonly used antibiotics in Zambia. Methods: A cross-sectional study was conducted. Trolleys and basket handles were swabbed and standard microbiological methods were used to identify the bacteria and disc diffusion to determine their antimicrobial susceptibility status. Data was collected from December 2021 to April 2022. Data was analysed using IBM Statistical Package for Social Sciences (SPSS) Version 22. Results: Twenty-eight percent of the 200 total samples were found to be culture-positive and predominant isolates were Staphylococcus aureus (17.3%), Pseudomonas species (4.5%), Escherichia coli (2%), Corynebacterium species (2%), Staphylococcus species (1.5%) and Enterobacter aerogenes (0.5%). Staphylococcus aureus showed the most resistance to azithromycin (17%) followed by ciprofloxacin (2.8%), nitrofurantoin (2.8%) and chloramphenicol (2.8%). Escherichia coli showed 100% resistance to amoxicillin, cloxacillin and ampicillin, 75% resistance to ciprofloxacin and the least resistance to azithromycin (25%) while it was susceptible to nitrofurantoin. Staphylococcus species, Corynebacterium species, Enterobacter aerogenes and Pseudomonas species showed no resistance to any antibiotics. Conclusion: The study showed the presence of microorganisms with considerable antimicrobial resistance to antibiotics in Zambia on trolley and basket handles indicating the need for more initiatives to address proper hygiene in public environmental sites for better infection prevention and control.
文摘Among Chinese woven products, bamboo baskets have the widest of uses. They are light and durable and graceful. Bamboo baskets have been indispensable for hundreds of years in South China. there are large varieties of bamboo baskets in China, but the best are those made by the local people in eastern Zhejiang Province, especially in Shengxian and Dongyang. These places have a long history in bamboo basket making and work is well-known nationwide. The baskets from there
文摘Background: Complications after endoscopic retrieval of kidney and ureter stones are obviously related to the size of the stones as well as the experience of the surgeon and other factors. During the procedure it is sometimes difficult for surgeons to estimate stone size and therefore give prognostic advises. The visual perception of the stone size depends on the shape, colour, distance to the renoscope and dilatation of the ureter. This is the so-called binding problem, because shape, color and direction of motion are processed separately by different population of optical neurons. In order to establish a better prognostic rational especially for less experienced surgeons, we established an intra operative semi-quantitative measurement of the stone size supported by a stone basket. Materials and Methods: We modified the tipped, nitinol stone baskets from the company Urotech with diameters of 2.5, 3.0 and 4 FR. The handle of this basket has a spring mechanism, which automatically closes the basket and provides a predefined fixation force of the stones within the basket. On the handle we established a non-linear scale in mm by grabbing standardized balls or standardized screws. Result: The scales are nonlinear because of the nonlinear relation between the diameter of the stone and the distance of the slider. Also the scales differ in between the basket size, because of the different strain conditions due to the different wire sizes and materials or the spring and basket. Conclusion: This scale could be an important orientation for a surgeon during endourological procedures to estimate stone sizes. After further clinical experience a semi-quantitative visualization like green, yellow and red colors could help to predict potential complications due to large stone sizes. Finally it could bevery interesting for other disciplines like gastroenterology.
基金supported by grants from the National Nat-ural Science Foundation of China(82222012 and 82120108006)Scientific Innovation Program of Shanghai Municipal Education Committee(201901070007E00052)。
文摘Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controversial.This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions.Methods:We compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions.We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital,Naval Medical University between February 2012 and December 2021.After propensity score matching(1:1),101 patients were included in each group.The primary outcome was the rate of pancreatic stone clearance.Secondary outcomes included the rate of adverse events during hospitalization,long-term pain relief,and quality of life after one year follow-up period.Results:The rate of complete clearance was comparable between the two groups(86.1%vs.84.2%,P=0.692).In patients with stones≥2 cm before extracorporeal shock wave lithotripsy(ESWL),the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group[100%(19/19)vs.70.0%(14/20),P=0.031].In the multivariate logistic analysis,ESWL prior to stone extraction was the only independent predictor of complete clearance[with ESWL 58.4%(264/452)vs.without ESWL 41.6%(188/452),odds ratio=2.3,95%confidence interval:1.2–4.3;P=0.013].No significant differences between groups were found regarding the rates of adverse events during hospitalization,quality of life,and pain relief after one year of follow-up.Conclusions:Basket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions.However,the balloon catheter was superior to the basket catheter if the pancreatic stone size was≥2 cm before ESWL.
文摘Once a mining village,Jingshan in Hangzhou has reinvented itself over the past 20 years as a thriving model of green transformation.STROLLING through a village named Jingshan located in Hangzhou City,east China’s Zhejiang Province,one will notice the image of a“little tea farmer”wearing a bamboo hat and carrying a tea basket in many places.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses on the surgical management of key ERCP-related complications:Post-sphincterotomy bleeding,perforations,stent migration-induced perforations,and Dormia basket impaction.Although many complications can be managed endoscopically,surgery remains essential in refractory cases or when less invasive methods fail.Post-sphincterotomy bleeding,although often controlled endoscopically,may necessitate surgical ligation when hemorrhage persists.Perforations,classified by anatomical type,require tailored surgical approaches-primary repair for type I and biliary diversion with defect closure for types II and III.Stent migration-induced perforations,which may lead to peritonitis or abscess formation,often require surgery due to their variable clinical presentation and the lack of standardized management guidelines.Dormia basket impaction,although rare,may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective.Early recognition,multidisciplinary collaboration,and individualized treatment strategies are pivotal in reducing morbidity and mortality.This review underscores evolving surgical approaches,emphasizing the importance of timely,patient-specific decisions to improve outcomes in severe ERCP-related complications.
文摘For genome mulUplication hepadnaviruses use the transcriptional machinery of the cell that is found within the nucleus. Thus the viral genome has to be transported through the cytoplasm and nuclear pore. The intracytosolic translocation is facilitated by the viral capsid that surrounds the genome and that interacts with cellular microtubules. The subsequent passage through the nuclear pore complexes （NPC） is mediated by the nuclear transport receptors importin α andβ. Importin α binds to the C-terminus of the capsid protein that comprises a nuclear localization signal （NLS）. The exposure of the NLS is regulated and depends upon genome maturation and/or phosphorylation of the capsid protein. As for other karyophilic cargos using this pathway importin α interacts with importin β that facilitates docking of the import complex to the NPC and the passage through the pore. Being a unique strategy, the import of the viral capsid is incomplete in that it becomes arrested inside the nuclear basket, which is a cage-like structure on the karyoplasmic face of the NPC. Presumably only this compartment provides the factors that are required for capsid disassembly and genome release that is restricted to those capsids comprising a mature viral DNA genome.
基金Supported by Grant from Inha University Research
文摘Mechanical lithotripsy （ML） is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no es- tablished endoscopic extraction method for such gi- ant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct （CBD）. Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An at- tempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capturethe stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangio- pancreatography; each of which took 30 rain. No com- plications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones.
文摘Foreign body ingestion is a common emergency situation in children with one or a few objects having been ingested. Here we report our experience using endo-scopic retrieval in a female centenarian with dyspnea and foreign bodies in the esophagus. She attempted suicide by swallowing 26 coins and two other foreign bodies. A gastroscope was used to remove all foreign bodies in the lower esophagus. In total, 26 coins, one ferrous ring and one cylindrical plastic object were retrieved. To our knowledge, this is the first clinical report on retrieval of so many foreign bodies in a single case.
基金supported by a grant from JEIL Pharmaceuticals (Seoul, Korea)
文摘BACKGROUND： A previous report has identified a significantly higher sensitivity of cancer detection for dedicated grasping basket than brushing at endoscopic retrograde cholangiopancreato- graphy （ERCP）. This study aimed to compare the diagnostic accuracy of Geenen brush and Dormia basket cytology in the differential diagnosis of bile duct stricture. METHOD： The current study enrolled one hundred and fourteen patients who underwent ERCP with both Geenen brush and Dormia basket cytology for the differential diagnosis of bile duct stricture at our institution between January 2008 and December 2012. RESULTS： We adopted sequential performances of cytologic samplings by using initial Geenen brush and subsequent Dormia basket cytology in 59 patients and initial Dormia basket and subsequent Geenen brush cytology in 55 patients. Presampling balloon dilatations and biliary stentings for the stricture were performed in 17 （14.9%） and 107 patients （93.9%）, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Geenen brush cytology for the diagnosis of malignant bile duct stricture were 75.0%, 100.0%, 100.0%, 66.7% and 83.3%, respectively, and those of Dormia basket cytology were 64.5%, 100.0%, 100.0%, 58.5% and 76.3%, respectively （P=0.347 and 0.827 for sensitivity and accuracy, respectively）. The good and excellent cellular yields （≥grade 2） were obtained by Geenen brush and Dormia basket cytology in 88 （77.2%） and 79 （69.3%） patients, respectively.CONCLUSION： The sensitivity, specificity and accuracy of biliary sampling with a Dormia basket are comparable to those with conventional Geenen brush cytology in the detection of malignant bile duct stricture.
文摘The treatments for common bile duct (CBD) stones are being continually developed. Impaction of the lithotripsy basket during endoscopic removal of CBD stones was seen in 5.9% patients. We report the case of a 66-yearold woman who underwent surgery for the removal of an impacted biliary basket. She was admitted to our hospital with a complaint of right upper abdominal pain. Magnetic resonance cholangiopancreatography revealed a CBD stone (20 mm × 15 mm). We diagnosed her with choledocholithiasis and performed endoscopic retrograde cholangiopancreatography to remove the stone. However, unfortunately, the retrievable basket around the stone became impacted. An endotriptor along with forceps could not be used owing to the entrapment of the basket, and thus we performed urgent surgery. The basket containing the stone was removed through a longitudinal choledochotomy. The wires leading to the basket were cut, and the basket containing the stone was removed via the incision. A T-tube was inserted,and the choledochotomy was closed. The postoperative course was uneventful. In conclusion, if the diameter of a CBD stone is more than 20 mm, then the risk of basket impaction increases, and surgery may be necessary as the initial treatment of the CBD stone.
基金the support of this work at Penn State by the U.S.Department of Energy,National Energy Technology Laboratorythe financial support by the China Scholarship Council,the Natural Science Foundation of China(No.51176034)the Open Fund of Key Laboratory of Coal-Based CO2 Capture and Geological Storage of Jiangsu Province(2016A05)
文摘The objective of this work is to study the influences of silica supports and PEG additive on the sorption performance of molecular basket sorbent（MBS） for COcapture consisting of polyethylenimine and one of the following supports: SBA-15（2-D structure）, TUD-1（3-D sponge-like structure） and fumed silica HS-5（3-D disordered structure）. Effects of the supports regarding pore structures and pore properties, the PEI loading amount as well as the sorption temperature were examined. Furthermore, polyethylene glycol（PEG） was introduced as an additive into the sorbents and its effect was investigated at different PEI loadings and sorption temperatures. The results suggest that the pore properties of MBS（after PEI loading） play a more important role in the COsorption capacity, rather than those of the supports alone.MBS with 3D pore structure exhibits higher COsorption capacity and amine efficiency than those with 2D-structured support. Among the sorbents studied, fumed silica（HS-5） based MBS showed the highest COsorption capacity in the temperature range of 30-95 °C, probably due to its unique interstitial pores formed by the aggregation of polymer-loaded SiOparticles. It was found that the temperature dependence is directly related to the PEI surface coverage layers. The more PEI surface coverage layers, the higher diffusion barrier for COand the stronger temperature dependence of COcapacity. 3D MBS exceeds 2D MBS at the same PEI coverage layers due to lower diffusion barrier. Adding PEG can significantly enhance the COsorption capacity and improve amine efficiency of all MBS, most likely by alleviating the diffusion barrier within PEI bulk layers through the inter-molecular interaction between PEI and PEG.
文摘AIM:To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography(ERCP) procedure.METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients.These patients were immediately operated for removal of stone(s) and impacted basket.The postoperative course,length of hospital stay,diameter of the stone,complication and the surgical procedure of the patients were reported retrospectively.RESULTS: Six patients(M/F,0/6) were operated due to impacted basket during ERCP procedure.The mean age of the patients was 64.33 ± 14.41 years.In all cases the surgery was performed immediately after the failed ERCP procedure by making a rightsubcostal incision.The baskets containing the stone were removed through longitudinal choledochotomy with the stone.The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients.All patients were also performed cholecystectomy additionally since they had cholelithiasis.In patients with T-tube placement it was removed on the 13 th day after a normal T-tube cholangiogram.The patients remained stable at postoperative period and discharged without any complication at median 7 d.CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.
基金supported by a grant from the First Affiliated Hospital of Kunming Medical University (2015BS015)grants from the joint projects of Yunnan Province (40215003, H-201639 and 2017FE468(-250))a grant from the Ministry of Science and Technology of the People’s Republic of China (2011BAK04B04)
文摘Gamma band oscillation（GBO） and sensory gating（SG） are associated with many cognitive functions.Ketamine induces deficits of GBO and SG in the prefrontal cortex（PFC）. However, the time-courses of the effects of different doses of ketamine on GBO power and SG are poorly understood. Studies have indicated that GBO power and SG have a common substrate for their generation and abnormalities. In this study, we found that（1） ketamine administration increased GBO power in the PFC in rats differently in the low-and high-dose groups;（2） auditory SG was significantly lower than baseline in the 30 mg/kg and 60 mg/kg groups, but not in the 15 mg/kg and 120 mg/kg groups; and（3） changes in SG and basal GBO power were significantly correlated in awake rats. These results indicate a relationship between mechanisms underlying auditory SG and GBO power.
文摘The market trends rapidly changed over the last two decades.The primary reason is the newly created opportunities and the increased number of competitors competing to grasp market share using business analysis techniques.Market Basket Analysis has a tangible effect in facilitating current change in the market.Market Basket Analysis is one of the famous fields that deal with Big Data and Data Mining applications.MBA initially uses Association Rule Learning(ARL)as a mean for realization.ARL has a beneficial effect in providing a plenty benefit in analyzing the market data and understanding customers’behavior.An important motive of using such techniques is maximizing the business profit as well as matching the exact customer needs as closely as possible.In this survey paper,we discussed several applications and methods of MBA based on ARL.Also,we reviewed some association rule learning measurements including trust,lift,leverage,and others.Furthermore,we discuss some open issues and future topics in the area of market basket analysis and association rule learning.
文摘Fracture of the central lead wire of an impacted basket during a mechanical lithotripsy for large common bile duct(CBD) stones poses a special challenge.Different maneuvers have been described to resolve this problem.Most techniques require equipment or facilities which may not be readily available in small community hospitals.We present here a similar situation in a patient with a large stone at the level of the cystic duct.Through the duodenoscope,a smaller Dormia basket was introduced into the CBD along the side of the impacted broken basket.The tip of the impacted basket was grasped and,by pulling downwards,the basket was disengaged from the stone.The two baskets were then removed successfully.We suggest this simple technique should be tried initially,before resorting to more advanced procedures.
