OBJECTIVE:To compare the composition changes of Aurantii fructus before and after fermentation processing and optimize its fermentation processing technology. METHODS:UPLC was conducted to compare the raw and fermentation processed products of same batch of Aurantii fructus,and ensure the chromatographic peaks after fermentation processing. Using peak areas of 4 chromatographic peaks and mildew characteristics of samples as index,fermentation temperature,humidity and time as factor, L9(34)orthogonal test was designed to optimize the fermentation processing technology,and verified it. RESULTS:After fermenta-tion processing,Aurantii fructus obviously showed 2 new monosaccharide glycosides components;the optimized fermentation tech-nology was as follows as fermentation temperature of 30 ℃,humidity of 70% and time of 7 d;verification test results showed RSD of each indicator of decoction pieces prepared by optimized fermentation technology in 3 tests were lower than 2.0%(n=3). CONCLUSIONS:Fermentation processing may lead obvious chemical composition changes in Aurantii fructus;the optimized fer-mentation processing technology can increase the contents of characteristic peaks.

OBJECTIVE:To compare the acute toxicity of ethanol extract from raw product and different processed products of Wikstroemia indica on mice,and provide basis for optimizing the processing technology of perspiration method for W. indica and medication safety. METHODS:Perspiration method was used to process the W. indica pieces for 30 d to get processed product 1 and process its coarse powder for 14,7 d to get processed product 2,processed product 3,respectively. Then using 70％ ethanol as solvent,percolation method was used to extract the raw W. indica and its different processed products,and acute toxicity test was conducted on mice for different ethanol extracts. RESULTS:The median lethal dose(LD50)of ethanol extracts from raw W. in-dica and processed product 1 were 4.05 and 6.65 g/kg,equivalent to 19,32 times of the clinical daily dose of a 70 kg adult,re-spectively. While the LD50 of ethanol extract from processed product 2 and processed product 3 can not be measured,the maximum tolerated dose(MTD)were measured as 20.0,15.0 g/kg,equivalent to 95,71 times of the clinical daily dose of a 70 kg adult,re-spectively;the maximum dose(MLD)were measured as approximately 30.0,20.0 g/kg,equivalent to 143,95 times of the clini-cal daily dose of a 70 kg adult,respectively. CONCLUSIONS:The toxicity of processed products of W. indica is obviously lower than that of raw products,and its toxicity after processing the coarse powder for 14 d is lower than that after processing the coarse powder for 7 d.

Objective: To study the feasibility, safety and aesthetics of laparoscopic cholecystectomy using a single-port through the umbilicus in patients with chronic cholecystitis with cholecystolithiasis. Methods: From Jan 2007 to Jun 2017, the clinical data of 4790 patients who underwent single-port, 4 426 patients conventional three-ports, and 3 304 patients two-ports laparoscopic cholecystectomy were retrospectively studied. Results: There were no death in all the three groups. There were no significant differences in the incidences of postoperative bleeding, bile leakage, biliary tract injury and other significant short-term complications (all P>0.05). The operation time of transumbilical single-port laparoscopic cholecystectomy was significantly longer than that of two-ports and three-ports laparoscopic cholecystectomy [(35.3±9.0)min vs. (28.4±7.2)min vs. (23.3±6.4)min, P<0.05]. Looking only in a single year, there was no significant difference in the operation time of the three groups in the year 2017 (P>0.05). There were no significant differences among the three groups in intraoperative blood loss, first postoperative passing of flatus, postoperative pain, and length of hospital stay (all P>0.05). The satisfaction score of surgical scar in the single-port group was higher than that in the two-ports and three-ports groups [(9.6±1.6) vs. (7.6±1.9) vs. (6.7±2.0), P<0.05]. Conclusions Transumbilical single-port laparoscopic cholecystectomy was safe and feasible, with good aesthetics and other advantages. It was more difficult than the traditional laparoscopic technique. After the learning curve, the operation time could be comparable to the three-ports technique.

Objective:To evaluate the preventive effect of indwelling pancreatic duct guide wire through nasobiliary drainage catheter for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in cholelithiasis patients with small-caliber pancreatic duct.Methods:The clinical data of 127 patients with gall bladder and common bile duct stones undergoing ERCP and elective laparoscopic cholecystectomy in the Cholelithiasis Center of Shanghai East Hospital Affiliated to Tongji University from January 2019 to June 2023 were analyzed retrospectively, including 55 males and 72 females, aged (56.95±10.86) years old. According to the preventive methods of PEP, patients were divided into the guide wire group (indwelling pancreatic duct guide wire through nasobiliary drainage catheter), stenting group (nasobiliary catheter with 5Fr 5 cm single pigtail pancreatic duct stent) and conventional group (nasobiliary catheter). The incidence of post-ERCP hyperamylasemia (PEH) and PEP were compared.Results:The incidence of PEH in the guide wire group was lower than that in the conventional group [17.8% (8/45) vs. 43.5% (10/23), P=0.023], and also lower than that in the stenting group [17.8% (8/45) vs. 32.2% (19/59)], despite no statistical significance ( P=0.337). The incidences of PEH were comparable in the stenting group and conventional group [32.2% (19/59) vs. 43.5% (10/23), P=0.096)]. The incidence of PEP in the guide wire group was lower than that in both the stenting group [6.7% (3/45) vs. 23.7% (14/59), P=0.030]. and conventional group [6.7% (3/45) vs. 30.4% (7/23), P=0.025]. The incidences of PEP were comparable in the stenting and conventional group [23.7% (14/59) vs. 30.4% (7/23), P=0.532]. Conclusion:Compared to the preventive pancreatic duct stenting, indwelling pancreatic duct guide wire through nasobiliary drainage catheter can effectively prevent the PEH and PEP in high-risk patients with a small-caliber pancreatic duct.

Objective: To explore the application of septoplasty and cheiloplasty in complete unilateral cleft lip repairment, and evaluate the effect on nasal shape correction. Methods: Twenty-four infants with complete unilateral cleft lip were divided into two groups: the correction group and the control group. Both groups underwent cheiloplasty by Mohler′s technique, septoplasty was performed in the correction group during the primary cheiloplasty. Six-month follow-up was taken to evaluate the nasal shape with the three dimensional images. Independent-samples t Test was performed using SPSS 21.0, to compare the nasal morphology between two groups. Results: All patients healed in the first stage, and were followed for 6 months after operations. There were no complication, including nasal septum perforation, occurred in either group.There were statistically significant differences in nasal parameters between the correction group and controls (P<0.05). The columellar width, nostril width on the affected side, and columella deviation of the correction group were smaller, than those of controls. The nose tip height, columellar height and nostril height on the affected side of the correction group were greater than those of the control group. Conclusions Septoplasty associated with the primary cheiloplasty in complete unilateral cleft lip repairment, shows better results in the elongation of the nasal columella, and the correction of septum deviation, and provides a stable nasal structure.

Objective:To study the feasibility and safety of percutaneous jejunal drainage in treatment of hepatolithiasis after choledochojejunostomy.Methods:The clinical data of 24 patients with hepatolithiasis after choledochojejunostomy treated by percutaneous jejunal drainage at the Cholelithiasis Center, Shanghai East Hospital Affiliated to Tongji University from May 2021 to May 2022 were retrospectively analyzed. There were 16 males and 8 females, aged (50.46±10.89) years old. Ultrasound and X ray guided percutaneous jejunography was performed under local anesthesia for patients with hepatolithiasis after choledochojejunostomy. Then the fistula was directly dilated to 16.0Fr, and percutaneous jejunal choledochoscopy was performed 3 days later. The success rate, complication rate and stone removal rate were analysed.Results:Twenty-four patients were treated with percutaneous jejunography, with a success rate of 79.2%(19/24), including 19 patients after anterior colonic cholangiojejunostomy with a success rate of 94.7%(18/19), and 5 patients after retrocolonic cholangiojejunostomy with a success rate of 20.0%(1/5). There was no complication including bleeding, intestinal leakage and bile leakage. In 19 patients with successful percutaneous jejunography, the success rate of fistula dilation was 100%(19/19), and there was no complication. Five patients with failed percutaneous jejunography underwent open choledocholithotomy through the jejunal output-loop, and bile leakage occurred in one patient. Thirteen patients with anastomotic stenosis, 5 with intrahepatic biliary strictures, and 6 with anastomotic and intrahepatic biliary strictures were diagnosed by choledochoscopy and selective cholangiography in these 24 patients. After choledochoscopic electrotomy, cylindrical balloon dilation, stone removal, stenting and other treatments, the stenosis relief rate was 100%(24/24), and the clearance rate of intrahepatic bile duct stones was 91.7%(22/24).Conclusion:Percutaneous jejunal drainage was a feasible, safe and minimally invasive method for treatment of hepatolithiasis after choledochojejunostomy. The procedure was especially suitable for patients with anterior colonic cholangiojejunostomy.

OBJECTIVE To study the toxicity of the extract from Mi ao medicine Wikstroemia indica to zebrafish . METHODS Zebrafish embryo model was used as the object ，after exposure to W. indica extract （10，20，40 μg/mL），the number of spontaneous twitching within 1 min，heart rate within 10 s，the occurrence of malformation and death were detected and recorded . Zebrafish was used as the object ，after exposure to W. indica extract（10-100 μg/mL）for 24，48 and 72 h，and the median lethal concentration（LC50）of W. indica extract to zebrafish at different time points were calculated . After exposure to low ，medium and high concentration （27，37，51 μg/mL）of W. indica extract，the liver phenotype ，hepatocyte apoptosis and lipid deposition of zebrafish were observed ，and the activities of alanine aminotransferase （ALT），aspartate aminotransferase （AST）and lactate dehydrogenase（LDH）in liver tissue were detected . RESULTS Compared with blank group ，the number of spontaneous twitching ， malformation rate （except for 10 μg/mL group ）and mortality of embryos increased significantly in 10，20，40 μg/mL groups of W. indica extract，and the heart rate （except for 10，20 μg/mL group ）of embryos decreased significantly （P＜0.05）. LC50 of W. indica extract to zebrafish at 24，48 and 72 h were 39.850，28.300 and 21.490 μg/mL，respectively. After drug treatment ，the transparency of liver area of zebrafish in low ，medium and high concentration groups of W. indica extract reduced and their shape were enlarged；apoptosis and lipid deposition increased ；the activities of ALT ，AST and LDH in liver tissue were significantly increased （P＜0.05）. CONCLUSIONS Miao medicine W. indica extract had develop mental toxicity to zebrafish embryos and he patotoxicity to zebrafish .